Provider Demographics
NPI:1114163201
Name:TORRES, LISA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:TORRES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 PARK AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2025
Mailing Address - Country:US
Mailing Address - Phone:669-244-0793
Mailing Address - Fax:
Practice Address - Street 1:1769 PARK AVE STE 210A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2025
Practice Address - Country:US
Practice Address - Phone:408-457-8981
Practice Address - Fax:408-457-8981
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48946106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12349489OtherCAQH