Provider Demographics
NPI:1811310410
Name:TORRES, LISSA
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name: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 1:2095 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1602
Mailing Address - Country:US
Mailing Address - Phone:305-642-9800
Mailing Address - Fax:305-971-3095
Practice Address - Street 1:2095 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1602
Practice Address - Country:US
Practice Address - Phone:305-642-9800
Practice Address - Fax:305-971-3095
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL762933101Y00000X
101YM0800X, 103K00000X, 103TB0200X, 106H00000X, 132700000X, 174H00000X, 225100000X, 225X00000X, 235Z00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No174H00000XOther Service ProvidersHealth Educator
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist