Provider Demographics
NPI:1073990024
Name:TORRES, RAIZA Y (LIC)
Entity Type:Individual
Prefix:MISS
First Name:RAIZA
Middle Name:Y
Last Name:TORRES
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-0993
Mailing Address - Country:US
Mailing Address - Phone:787-901-5271
Mailing Address - Fax:
Practice Address - Street 1:92 CALLE LUCHETTI
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-0993
Practice Address - Country:US
Practice Address - Phone:787-901-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4767103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist