Provider Demographics
NPI:1215125836
Name:YANG, OLIVIA S (LCSW)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:S
Last Name:YANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 N MARCEY ST
Mailing Address - Street 2:STE. 535
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5373
Mailing Address - Country:US
Mailing Address - Phone:312-280-1166
Mailing Address - Fax:312-280-1199
Practice Address - Street 1:1731 N MARCEY ST
Practice Address - Street 2:STE. 535
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5373
Practice Address - Country:US
Practice Address - Phone:312-280-1166
Practice Address - Fax:312-280-1199
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490138881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical