Provider Demographics
NPI:1598028532
Name:TORRES, JILLIAN M (MSED)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:M
Last Name:TORRES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1520
Mailing Address - Country:US
Mailing Address - Phone:718-556-1516
Mailing Address - Fax:718-442-9962
Practice Address - Street 1:1535 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1520
Practice Address - Country:US
Practice Address - Phone:718-556-1516
Practice Address - Fax:718-442-9962
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY830446252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency