Healthcare Provider Details

I. General information

NPI: 1891914859
Provider Name (Legal Business Name): MARY ANNE LA TORRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31546 SASSAFRAS RIVER AVE
GALENA MD
21635-1349
US

IV. Provider business mailing address

31546 SASSAFRAS RIVER AVE
GALENA MD
21635-1349
US

V. Phone/Fax

Practice location:
  • Phone: 410-648-5764
  • Fax:
Mailing address:
  • Phone: 410-648-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR132273
License Number StateMD

VIII. Authorized Official

Name: MARY ANNE LA TORRE
Title or Position: PSYCHIATRIC CLINICAL NURSE SPECIALI
Credential: R.N., M.A.
Phone: 410-648-5764