Healthcare Provider Details

I. General information

NPI: 1588286611
Provider Name (Legal Business Name): MARISSA TORRES BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 US HIGHWAY 1 STE 210
NORTH PALM BEACH FL
33408-3547
US

IV. Provider business mailing address

111 E LAKE MARY BLVD
SANFORD FL
32773-7111
US

V. Phone/Fax

Practice location:
  • Phone: 561-776-8612
  • Fax:
Mailing address:
  • Phone: 407-203-9492
  • Fax: 321-332-9768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: