Provider Demographics
NPI:1649622465
Name:TORELLO, TANYA MICHELLE
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MICHELLE
Last Name:TORELLO
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 1:767 NE DAHOON TER
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4739
Mailing Address - Country:US
Mailing Address - Phone:772-301-8100
Mailing Address - Fax:
Practice Address - Street 1:767 NE DAHOON TER
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4739
Practice Address - Country:US
Practice Address - Phone:772-301-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist