MEDICARE: ROLANDA DENNIS RCSWI, MSW

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
2	1041C0700X	Clinical Social Worker	ISW16242	FL

General Provider Information

NPI Number	:	1548967433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLANDA DENNIS RCSWI, MSW

Provider Business Mailing Address
First Line	:	3551 S BLAIR STONE RD STE 105
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-8829
Country	:	US
Telephone Number	:	850-766-8873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 S BLAIR STONE RD STE 206
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-5928
Country	:	US
Telephone Number	:	850-544-2184
Fax Number	:

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

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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