Provider Demographics
NPI:1144009051
Name:WORSTER, MARK GALEN (RN-BSN, MCST)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:GALEN
Last Name:WORSTER
Suffix:
Gender:M
Credentials:RN-BSN, MCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 EDGEWATER DR # 6648
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:781-858-1421
Mailing Address - Fax:
Practice Address - Street 1:7 UNION ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1013
Practice Address - Country:US
Practice Address - Phone:781-858-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2293095163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health