Healthcare Provider Details

I. General information

NPI: 1104712975
Provider Name (Legal Business Name): LIGAYA ALLEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 E MONUMENT ST
BALTIMORE MD
21205-2431
US

IV. Provider business mailing address

2232 E MONUMENT ST
BALTIMORE MD
21205-2431
US

V. Phone/Fax

Practice location:
  • Phone: 443-942-6249
  • Fax: 301-276-4555
Mailing address:
  • Phone: 443-942-6249
  • Fax: 301-276-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number64056
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number64056
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC007994
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: