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NPI Code Detail

MEDICARE: WALTER O. ORELLANA LICSW

MEDICARE: WALTER O. ORELLANA LICSW
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
11041C0700XClinical Social WorkerISW02248RI

General Provider Information

NPI Number : 1154648343
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER O. ORELLANA LICSW
Provider Business Mailing Address
First Line : 530 N MAIN ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02904-5762
Country : US
Telephone Number : 401-276-4020
Fax Number :
Provider Business Practice Location Address
First Line : 530 NORTH MAIN ST.
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-2532
Country : US
Telephone Number : 401-276-4020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2010
Last Update Date : 09/19/2012

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