MEDICARE: DIANA ORLOW MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12066	FL

General Provider Information

NPI Number	:	1699201129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA ORLOW MA

Provider Business Mailing Address
First Line	:	8804 MANOR LOOP
Second Line	:	APT 203
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-3812
Country	:	US
Telephone Number	:	201-294-4466
Fax Number	:

Provider Business Practice Location Address
First Line	:	5454 LENA RD
Second Line	:	SUITE 106
City	:	BRADENTON
State	:	FL
Zip	:	34211-9499
Country	:	US
Telephone Number	:	201-294-4466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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Directions to “ DIANA ORLOW MA” Practice Location

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