Provider Demographics
NPI:1346986551
Name:DE LA TORRE, VICTORIA ADRIANA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ADRIANA
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ADRIANA
Other - Last Name:ZAMORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7515 W 60TH PL
Mailing Address - Street 2:
Mailing Address - City:SUMMIT ARGO
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1512
Mailing Address - Country:US
Mailing Address - Phone:312-405-6096
Mailing Address - Fax:
Practice Address - Street 1:715 LAKE ST STE 800
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1417
Practice Address - Country:US
Practice Address - Phone:847-331-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health