Healthcare Provider Details

I. General information

NPI: 1669706842
Provider Name (Legal Business Name): JUDIVELLY TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WARREN ST SB-BH PROGRAM
BOSTON MA
02135-3602
US

IV. Provider business mailing address

10 ORKNEY RD APT 22
BRIGHTON MA
02135-7717
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-3800
  • Fax: 617-779-1235
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: