Healthcare Provider Details

I. General information

NPI: 1013031319
Provider Name (Legal Business Name): JOSE B. TORRES PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W BROWN DEER RD
BROWN DEER WI
53209-1220
US

IV. Provider business mailing address

2024 E KENMORE PL
MILWAUKEE WI
53211-2124
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax: 414-540-2171
Mailing address:
  • Phone: 414-332-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2779-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: