Provider Demographics
NPI:1023340403
Name:TORRES, DIANISELLE (MA)
Entity type:Individual
Prefix:MRS
First Name:DIANISELLE
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 AVE ESMERALDA
Mailing Address - Street 2:141 COND. PLAZA ESMERALDA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4280
Mailing Address - Country:US
Mailing Address - Phone:787-203-8247
Mailing Address - Fax:787-998-4355
Practice Address - Street 1:469 AVE ESMERALDA
Practice Address - Street 2:141 COND. PLAZA ESMERALDA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4280
Practice Address - Country:US
Practice Address - Phone:787-203-8247
Practice Address - Fax:787-998-4355
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3695103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool