Provider Demographics
NPI:1073014668
Name:TORRES, MARYLIZ OLIVERAS
Entity Type:Individual
Prefix:
First Name:MARYLIZ
Middle Name:OLIVERAS
Last Name:TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22318 CALLE SAN PEDRO
Mailing Address - Street 2:URB EXT LA FE
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-8900
Mailing Address - Country:US
Mailing Address - Phone:787-225-2852
Mailing Address - Fax:
Practice Address - Street 1:22318 CALLE SAN PEDRO
Practice Address - Street 2:URB EXT LA FE
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-8900
Practice Address - Country:US
Practice Address - Phone:787-225-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR119201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical