Provider Demographics
NPI:1225293509
Name:TORRES, JEAN RIVERA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:RIVERA
Last Name:TORRES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 NE 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5557
Mailing Address - Country:US
Mailing Address - Phone:305-619-8099
Mailing Address - Fax:305-600-3713
Practice Address - Street 1:11440 N KENDALL DR STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1024
Practice Address - Country:US
Practice Address - Phone:305-929-8705
Practice Address - Fax:305-600-3713
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766066900Medicaid
FL766066900Medicaid