Healthcare Provider Details

I. General information

NPI: 1427863877
Provider Name (Legal Business Name): MARIO EZEQUIEL TORUNO TORREZ LCSW-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARIO EZEQUIEL TORUNO LCSWA

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UNION ST S STE 200
CONCORD NC
28025-5098
US

IV. Provider business mailing address

145 MOUNTAIN VIEW RD
SALISBURY NC
28147-8590
US

V. Phone/Fax

Practice location:
  • Phone: 704-918-9741
  • Fax: 704-270-6213
Mailing address:
  • Phone: 704-880-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018854
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: