Provider Demographics
NPI:1588069553
Name:TORRES, JANELLE AIXA (LCSW 62691)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:AIXA
Last Name:TORRES
Suffix:
Gender:F
Credentials:LCSW 62691
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 SAN LEANDRO BLVD.
Mailing Address - Street 2:FAMILY SERVICE OF SAN LEANDRO
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577
Mailing Address - Country:US
Mailing Address - Phone:510-483-6715
Mailing Address - Fax:510-483-6719
Practice Address - Street 1:2208 SAN LEANDRO BLVD.
Practice Address - Street 2:FAMILY SERVICE OF SAN LEANDRO
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577
Practice Address - Country:US
Practice Address - Phone:510-483-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LCSW62691104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker