Healthcare Provider Details

I. General information

NPI: 1295525632
Provider Name (Legal Business Name): ANGELA LAROCHELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 TEWKSBURY ST
ANDOVER MA
01810-5841
US

IV. Provider business mailing address

49 TEWKSBURY ST
ANDOVER MA
01810-5841
US

V. Phone/Fax

Practice location:
  • Phone: 617-595-5106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2325285
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: