Healthcare Provider Details

I. General information

NPI: 1265440879
Provider Name (Legal Business Name): SUSAN TORRES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W A ST
DIXON CA
95620-3437
US

IV. Provider business mailing address

131 W A ST
DIXON CA
95620-3437
US

V. Phone/Fax

Practice location:
  • Phone: 707-635-1631
  • Fax: 707-635-1639
Mailing address:
  • Phone: 707-635-1631
  • Fax: 707-635-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number19743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: