Healthcare Provider Details

I. General information

NPI: 1154648343
Provider Name (Legal Business Name): WALTER O. ORELLANA LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NORTH MAIN ST.
PROVIDENCE RI
02906-2532
US

IV. Provider business mailing address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4020
  • Fax:
Mailing address:
  • Phone: 401-276-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02248
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: