Provider Demographics
NPI:1215385919
Name:TORRES, ELIZABETH (BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:BCBA
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 186
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:VT
Mailing Address - Zip Code:05829-0186
Mailing Address - Country:US
Mailing Address - Phone:619-300-4211
Mailing Address - Fax:
Practice Address - Street 1:4088 HINMAN SETTLER RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855
Practice Address - Country:US
Practice Address - Phone:619-300-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT146.0119804103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst