Provider Demographics
NPI:1699395236
Name:TORRE, MARK ERNEST (MED, LMHC MCAP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ERNEST
Last Name:TORRE
Suffix:
Gender:M
Credentials:MED, LMHC MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 LAKE SHORE DR APT 611
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2930
Mailing Address - Country:US
Mailing Address - Phone:973-903-6366
Mailing Address - Fax:
Practice Address - Street 1:1001 W INDIANTOWN RD STE 107
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6830
Practice Address - Country:US
Practice Address - Phone:973-903-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health