Provider Demographics
NPI:1063798734
Name:TORRES, MARYLOU X (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARYLOU
Middle Name:
Last Name:TORRES
Suffix:X
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CALHOUN AVE
Mailing Address - Street 2:2ND FL.
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3302
Mailing Address - Country:US
Mailing Address - Phone:917-548-7068
Mailing Address - Fax:917-548-7068
Practice Address - Street 1:1000 CONEY ISLAND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1313
Practice Address - Country:US
Practice Address - Phone:718-434-1012
Practice Address - Fax:718-434-1088
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072795-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool