Provider Demographics
NPI:1225380140
Name:TORRES HERNANDEZ, LISSETTE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:
Last Name:TORRES HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
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 351
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0351
Mailing Address - Country:US
Mailing Address - Phone:787-673-4608
Mailing Address - Fax:
Practice Address - Street 1:70 CALLE RELAMPAGO
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3583
Practice Address - Country:US
Practice Address - Phone:787-673-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4223103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling