Provider Demographics
NPI:1205685583
Name:AGNIS PENA-TORO CORP
Entity type:Organization
Organization Name:AGNIS PENA-TORO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST - CEO
Authorized Official - Prefix:
Authorized Official - First Name:AGNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENA-TORO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:617-230-0069
Mailing Address - Street 1:318 RINDGE AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-3149
Mailing Address - Country:US
Mailing Address - Phone:617-230-0069
Mailing Address - Fax:617-714-4916
Practice Address - Street 1:318 RINDGE AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-3149
Practice Address - Country:US
Practice Address - Phone:617-230-0069
Practice Address - Fax:617-714-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)