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General NPI Number Information
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NPI Number | 1679017735
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Entity Type | Individual
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Provider Name | OLIVIA LYNN CAROLLO PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 4527 N RAVENSWOOD AVE UNIT 105
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City | CHICAGO
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State | IL
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Zip | 60640-5201
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Country | US
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Telephone | 312-764-1244
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Fax | 312-586-8089
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Provider Business Mailing Address
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Address Line | 4851 N CLAREMONT AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60625-1909
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Country | US
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Telephone | 727-480-9038
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009421
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License Number State | IL
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