Provider Demographics
NPI:1609516087
Name:TORRES MORON, LAURA ESTHER (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ESTHER
Last Name:TORRES MORON
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 CHACE LN NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5503
Mailing Address - Country:US
Mailing Address - Phone:786-879-6392
Mailing Address - Fax:
Practice Address - Street 1:912 CHACE LN NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5503
Practice Address - Country:US
Practice Address - Phone:786-879-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2-11-80868106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician