Provider Demographics
NPI:1376200436
Name:TORRES, MARIANETTE (PHD)
Entity Type:Individual
Prefix:
First Name:MARIANETTE
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARIANETTE
Other - Middle Name:
Other - Last Name:TORRES DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO STE 102
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:331 CALLE COLL Y TOSTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4026
Practice Address - Country:US
Practice Address - Phone:787-232-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7281103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty