Provider Demographics
NPI:1316166226
Name:DE TORRES, CORY (PHD)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:DE TORRES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5597
Mailing Address - Country:US
Mailing Address - Phone:215-854-0800
Mailing Address - Fax:215-854-0440
Practice Address - Street 1:2129 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3503
Practice Address - Country:US
Practice Address - Phone:215-854-0800
Practice Address - Fax:215-854-0440
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002457L103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)