Healthcare Provider Details

I. General information

NPI: 1457105876
Provider Name (Legal Business Name): ANNAMARIA FLOODY TORMEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PROGRESS RD
GREENVILLE SC
29607-5703
US

IV. Provider business mailing address

14 PROGRESS RD
GREENVILLE SC
29607-5703
US

V. Phone/Fax

Practice location:
  • Phone: 864-553-9319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73378
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: