Healthcare Provider Details

I. General information

NPI: 1710354089
Provider Name (Legal Business Name): OLGA L. RIOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date: 01/05/2022
Reactivation Date: 07/19/2024

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

CMR 467 BOX 2114
APO AE
09096
US

V. Phone/Fax

Practice location:
  • Phone: 496-371-9464
  • Fax:
Mailing address:
  • Phone: 491-609-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010247
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: