Healthcare Provider Details

I. General information

NPI: 1013851195
Provider Name (Legal Business Name): LIZETTE OLVERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LEE ST STE 100
DES PLAINES IL
60016-4543
US

IV. Provider business mailing address

1150 N RIVER RD
DES PLAINES IL
60016-1290
US

V. Phone/Fax

Practice location:
  • Phone: 847-390-3004
  • Fax:
Mailing address:
  • Phone: 773-986-1173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: