Provider Demographics
NPI:1194740423
Name:TORRES, MARY T (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:TORRES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:THERESE
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4414 CENTERVIEW STE 152
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1418
Mailing Address - Country:US
Mailing Address - Phone:210-694-4233
Mailing Address - Fax:210-641-2099
Practice Address - Street 1:4414 CENTERVIEW STE 152
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1418
Practice Address - Country:US
Practice Address - Phone:210-694-4233
Practice Address - Fax:210-641-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0056NNOtherBLUECROSS BLUESHIELD
001131OtherVALUE OPTIONS
TX12700041572000OtherTEXAS REHABILITATION COMM