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General NPI Number Information
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NPI Number | 1730425364
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Entity Type | Individual
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Provider Name | ORLANDO DAVIS L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 9204 S COMMERCIAL AVE SUITE 208
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City | CHICAGO
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State | IL
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Zip | 60617-2197
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Country | US
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Telephone | 312-489-7559
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Fax | 888-419-3986
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Provider Business Mailing Address
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Address Line | 9204 S COMMERCIAL AVE SUITE 208
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City | CHICAGO
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State | IL
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Zip | 60617-2197
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Country | US
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Telephone | 888-417-0274
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Fax | 888-419-3986
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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 | 149015621
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License Number State | IL
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