Provider Demographics
NPI:1487494415
Name:TORRES, MARIBEL (RCP, CNA)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:RCP, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 SUMMER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5366
Mailing Address - Country:US
Mailing Address - Phone:203-539-0133
Mailing Address - Fax:
Practice Address - Street 1:1372 SUMMER ST STE 200
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5361
Practice Address - Country:US
Practice Address - Phone:203-539-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 171400000X, 101YA0400X
CTNA654033376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171400000XOther Service ProvidersHealth & Wellness Coach
No376K00000XNursing Service Related ProvidersNurse's Aide