Healthcare Provider Details

I. General information

NPI: 1124460332
Provider Name (Legal Business Name): JOHANNA MARIE TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3688 E SHIELDS AVE
FRESNO CA
93726-6922
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-0635
  • Fax:
Mailing address:
  • Phone: 559-353-5270
  • Fax: 559-353-5286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1083
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: