Provider Demographics
NPI:1629746508
Name:TORRES, MYRA (MSW)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 WHIRLAWAY LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-3429
Mailing Address - Country:US
Mailing Address - Phone:630-605-9076
Mailing Address - Fax:
Practice Address - Street 1:1200 E INDIAN TRL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-1896
Practice Address - Country:US
Practice Address - Phone:630-256-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362169149OtherTAX ID