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General NPI Number Information
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NPI Number | 1467790766
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Entity Type | Individual
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Provider Name | OLIVIA D CHAVEZ PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/21/2013
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 2650 W MONTROSE AVE STE 307
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City | CHICAGO
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State | IL
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Zip | 60618-1561
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Country | US
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Telephone | 773-217-0277
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Fax |
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Provider Business Mailing Address
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Address Line | 4239 W WRIGHTWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60639-2059
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Country | US
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Telephone | 773-217-0277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.008494
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License Number State | IL
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