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General NPI Number Information
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NPI Number | 1508112368
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Entity Type | Individual
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Provider Name | CAROL ANN DELA TORRE LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 3134 WILLOW AVE STE 103
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City | CLOVIS
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State | CA
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Zip | 93612-4747
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Country | US
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Telephone | 559-647-1546
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Fax |
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Provider Business Mailing Address
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Address Line | 419 CIRCLE DR N
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City | FRESNO
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State | CA
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Zip | 93704-4760
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Country | US
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Telephone | 559-647-1546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16066
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License Number State | CA
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