Provider Demographics
NPI:1972213114
Name:TORRES, JUSTIN GABRIEL (LCSW-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GABRIEL
Last Name:TORRES
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 WHITESWORTH RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1401
Mailing Address - Country:US
Mailing Address - Phone:443-801-2108
Mailing Address - Fax:
Practice Address - Street 1:4601 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1906
Practice Address - Country:US
Practice Address - Phone:410-887-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD197101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical