Provider Information for 1043295140
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ORLY AVIDOR LCSW
Sex: Female
NPI: 1043295140
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1043295140 | ||||||||
| Enumeration Date | 2005-12-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2400 BELVIDERE RD WAUKEGAN, IL 60085-6165 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 2400 BELVIDERE RD WAUKEGAN, IL 60085-6165 United States Phone: 847-377-8440 | Fax: | ||||||||
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