Provider Demographics
NPI:1639455942
Name:TORRES, BETHSAIDA (LADC)
Entity Type:Individual
Prefix:MS
First Name:BETHSAIDA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SILVER ST
Mailing Address - Street 2:RUSHFORD CENTER-BEHAVIORAL HEALTH SERVICES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3946
Mailing Address - Country:US
Mailing Address - Phone:860-852-1093
Mailing Address - Fax:860-346-9041
Practice Address - Street 1:1250 SILVER ST
Practice Address - Street 2:RUSHFORD CENTER-BEHAVIORAL HEALTH SERVICES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3946
Practice Address - Country:US
Practice Address - Phone:860-852-1093
Practice Address - Fax:860-346-9041
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000886101YA0400X
CT002247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002247OtherDPH
CT000886OtherDPH