Provider Demographics
NPI:1699395236
Name:TORRE, MARK ERNEST (MED, LMHC MCAP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ERNEST
Last Name:TORRE
Suffix:
Gender:M
Credentials:MED, LMHC MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6233
Mailing Address - Country:US
Mailing Address - Phone:561-627-9701
Mailing Address - Fax:
Practice Address - Street 1:501 10TH ST
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3166
Practice Address - Country:US
Practice Address - Phone:888-734-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health