Provider Demographics
NPI:1174806434
Name:TORRES, JUAN R (MS)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:R
Last Name:TORRES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 EXECUTIVE PARK DR.
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:754-246-5618
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:2731 EXECUTIVE PARK DR.
Practice Address - Street 2:SUITE 9
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331
Practice Address - Country:US
Practice Address - Phone:754-246-5618
Practice Address - Fax:305-757-4465
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLIMFT1612106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist