Healthcare Provider Details

I. General information

NPI: 1710797642
Provider Name (Legal Business Name): ANA TESELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD STE 201
BALTIMORE MD
21212-3620
US

IV. Provider business mailing address

617 FRANKLIN AVE UNIT 12
BERLIN MD
21811-1358
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33241
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-402911
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: