MEDICARE: ANGELLE T SOLANO LMSW

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	101YP2500X	Professional Counselor	53107	TX
2	1041C0700X	Clinical Social Worker	53107	TX

General Provider Information

NPI Number	:	1447572953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELLE T SOLANO LMSW

Provider Business Mailing Address
First Line	:	PO BOX 2666
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77902-2666
Country	:	US
Telephone Number	:	361-575-8271
Fax Number	:	361-575-6520

Provider Business Practice Location Address
First Line	:	120 DAVID WADE DRIVE
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77905
Country	:	US
Telephone Number	:	361-575-8271
Fax Number	:	361-575-6520

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	05/27/2010

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