Healthcare Provider Details

I. General information

NPI: 1376345546
Provider Name (Legal Business Name): MARIELLA TORIBIO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9454 PARAGON CT
OWINGS MILLS MD
21117-1407
US

IV. Provider business mailing address

9454 PARAGON CT
OWINGS MILLS MD
21117-1407
US

V. Phone/Fax

Practice location:
  • Phone: 786-514-6811
  • Fax:
Mailing address:
  • Phone: 443-377-3618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC14989
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberLC14989
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: