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General NPI Number Information
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NPI Number | 1144985011
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Entity Type | Individual
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Provider Name | CYNTHIA SOLORIO TELLO MSW
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Gender | Female
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 8040 ORTONVILLE RD
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City | CLARKSTON
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State | MI
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Zip | 48348-4468
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Country | US
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Telephone | 248-989-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 24700 BOMBAY AVE
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City | WILMINGTON
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State | CA
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Zip | 90744-1111
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Country | US
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Telephone | 310-339-3931
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 95910
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License Number State | CA
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