Provider Demographics
NPI:1417203498
Name:TORRES, VICMAYRA (PSYD)
Entity Type:Individual
Prefix:
First Name:VICMAYRA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 830 KM 2.0
Mailing Address - Street 2:CERRO GORDO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-379-5673
Mailing Address - Fax:
Practice Address - Street 1:CALLE AUSTRAL 609
Practice Address - Street 2:URBANIZACION ALTAMIRA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-379-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical