Provider Demographics
NPI:1336961127
Name:TORRES, MARIANELA
Entity type:Individual
Prefix:
First Name:MARIANELA
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 1:633 NE 167TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2450
Mailing Address - Country:US
Mailing Address - Phone:786-400-6276
Mailing Address - Fax:
Practice Address - Street 1:633 NE 167TH ST STE 401
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2450
Practice Address - Country:US
Practice Address - Phone:954-433-6120
Practice Address - Fax:954-433-6121
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-385676106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty