Provider Demographics
NPI:1699389932
Name:DE LA TORRE, JOSE RAFAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAFAEL
Last Name:DE LA TORRE
Suffix:
Gender:M
Credentials:LCSW
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 668
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0668
Mailing Address - Country:US
Mailing Address - Phone:787-244-3097
Mailing Address - Fax:
Practice Address - Street 1:URB EL ENCANTO
Practice Address - Street 2:L-8 NARCISOS ST.
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-244-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR152621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical