=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578985099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALLY TORRES LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2014
-----------------------------------------------------
Last Update Date | 01/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8600 WOODWARD AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48202-2142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-875-7601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28747 JEFFERSON AVE
-----------------------------------------------------
City | SAINT CLAIR SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48081-2615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-439-8961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801035556
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------