Provider Demographics
NPI:1477868982
Name:TORRES DE MARIONA, TEONILA CLEOTILDE
Entity Type:Individual
Prefix:MS
First Name:TEONILA
Middle Name:CLEOTILDE
Last Name:TORRES DE MARIONA
Suffix:
Gender:F
Credentials:
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 18694
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-0694
Mailing Address - Country:US
Mailing Address - Phone:612-423-2377
Mailing Address - Fax:
Practice Address - Street 1:1844 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-4541
Practice Address - Country:US
Practice Address - Phone:612-423-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst