Healthcare Provider Details

I. General information

NPI: 1417211038
Provider Name (Legal Business Name): ANNIE DILLON OLLILA MSW LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 02/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 UNION ST 222
WORCESTER MA
01608-1194
US

IV. Provider business mailing address

27 LOCKE RD
RUTLAND MA
01543-2047
US

V. Phone/Fax

Practice location:
  • Phone: 508-317-2323
  • Fax:
Mailing address:
  • Phone: 508-849-5600
  • Fax: 508-865-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number217320
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117865
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: