Provider Demographics
NPI:1811246879
Name:DEBORRA M. TORRES, MSN, PMHNP, LLC
Entity type:Organization
Organization Name:DEBORRA M. TORRES, MSN, PMHNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP
Authorized Official - Phone:609-500-4018
Mailing Address - Street 1:4 FLAGSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8532
Mailing Address - Country:US
Mailing Address - Phone:609-500-4018
Mailing Address - Fax:609-388-4905
Practice Address - Street 1:5 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2439
Practice Address - Country:US
Practice Address - Phone:609-500-4018
Practice Address - Fax:609-388-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00116000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ29807Medicaid
165111BNPMedicare Oscar/Certification