Provider Demographics
NPI:1952870818
Name:TORRENTE, LUZ MIRYAN ALEXANDRA (BCBA)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MIRYAN ALEXANDRA
Last Name:TORRENTE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 HARBOUR SIDE DR SIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2768
Mailing Address - Country:US
Mailing Address - Phone:954-410-4106
Mailing Address - Fax:
Practice Address - Street 1:1581 HARBOUR SIDE DR SIDE DRIVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2768
Practice Address - Country:US
Practice Address - Phone:954-410-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12791235Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist