Provider Demographics
NPI:1386015881
Name:TORRES DIAZ, CARMEN ADRIANA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ADRIANA
Last Name:TORRES DIAZ
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W GRAN VIA ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6721
Mailing Address - Country:US
Mailing Address - Phone:956-563-3386
Mailing Address - Fax:
Practice Address - Street 1:1301 W GRAN VIA ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6721
Practice Address - Country:US
Practice Address - Phone:956-563-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-19803103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst