=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992610968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TESSA MARIE TORRES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2026
-----------------------------------------------------
Last Update Date | 08/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 COURT ST STE 3B
-----------------------------------------------------
City | CROMWELL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06416-1273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-613-9930
-----------------------------------------------------
Fax | 860-613-9952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 FARM HILL RD
-----------------------------------------------------
City | MERIDEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06451-5037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-613-9930
-----------------------------------------------------
Fax | 860-613-9930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Q00000X
-----------------------------------------------------
Taxonomy Name | Developmental Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------