Provider Demographics
NPI:1922701416
Name:SISCO TORRES, JEANNE MARIE
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:SISCO TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SAN ANTONIO 2545
Mailing Address - Street 2:CALLE DESPEDIDA
Mailing Address - City:PONCE, PR
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-629-8886
Mailing Address - Fax:
Practice Address - Street 1:URB SAN ANTONIO 2545
Practice Address - Street 2:CALLE DESPEDIDA
Practice Address - City:PONCE, PR
Practice Address - State:PR
Practice Address - Zip Code:00728-0072
Practice Address - Country:US
Practice Address - Phone:787-629-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7275103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool