MEDICARE: OLIVIA RIELI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW17555	FL

General Provider Information

NPI Number	:	1093587768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA RIELI LCSW

Provider Business Mailing Address
First Line	:	11849 PALM BAY PKWY APT 1203
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-1996
Country	:	US
Telephone Number	:	916-865-6990
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 RIVERSIDE AVE STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4439
Country	:	US
Telephone Number	:	912-674-5698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	03/20/2026

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