Healthcare Provider Details

I. General information

NPI: 1902297369
Provider Name (Legal Business Name): NANCY DE LA TORRE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12510 VAN NUYS BLVD STE 201
PACOIMA CA
91331-6732
US

IV. Provider business mailing address

100 W WALNUT ST STE 375
PASADENA CA
91103-3744
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-2255
  • Fax:
Mailing address:
  • Phone: 626-395-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW71999
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97910
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW97910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: