MEDICARE: MS. ORLY SHULMAN-KENNAN 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	44SC05332500	NJ

General Provider Information

NPI Number	:	1699082404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ORLY SHULMAN-KENNAN LCSW

Provider Business Mailing Address
First Line	:	101 38TH ST
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-1203
Country	:	US
Telephone Number	:	973-204-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 ESSEX ST
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1316
Country	:	US
Telephone Number	:	973-204-1005
Fax Number	:

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	09/01/2010

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