MEDICARE: ORLANDO DAVIS L.C.S.W.

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	1041C0700X	Clinical Social Worker	149015621	IL

General Provider Information

NPI Number	:	1730425364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORLANDO DAVIS L.C.S.W.

Provider Business Mailing Address
First Line	:	9204 S COMMERCIAL AVE
Second Line	:	SUITE 208
City	:	CHICAGO
State	:	IL
Zip	:	60617-2197
Country	:	US
Telephone Number	:	888-417-0274
Fax Number	:	888-419-3986

Provider Business Practice Location Address
First Line	:	9204 S COMMERCIAL AVE
Second Line	:	SUITE 208
City	:	CHICAGO
State	:	IL
Zip	:	60617-2197
Country	:	US
Telephone Number	:	312-489-7559
Fax Number	:	888-419-3986

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

Provider Enumeration Date	:	12/31/2012
Last Update Date	:	11/18/2015

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