MEDICARE: ANGELA VIRGINIA ORDYNIEC MSSW, LISW-CP, 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	086017	NY
2	1041C0700X	Clinical Social Worker	108725	CA
3	1041C0700X	Clinical Social Worker	29951	MN
4	1041C0700X	Clinical Social Worker	44SC06095500	NJ
5	1041C0700X	Clinical Social Worker	14924	SC

General Provider Information

NPI Number	:	1770067274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA VIRGINIA ORDYNIEC MSSW, LISW-CP, LCSW

Provider Business Mailing Address
First Line	:	1435 STUART ENGALS BLVD STE 201
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-7312
Country	:	US
Telephone Number	:	843-459-9805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 STUART ENGALS BLVD STE 201
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-7312
Country	:	US
Telephone Number	:	843-459-9805
Fax Number	:

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	08/25/2024

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