MEDICARE: TORRES COUNSELING LCSW, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	081869-1	NY

General Provider Information

NPI Number	:	1366955486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TORRES COUNSELING LCSW, P.C.

Provider Business Mailing Address
First Line	:	557 18TH ST
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-2205
Country	:	US
Telephone Number	:	631-252-2820
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 W MAIN ST STE 200
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8365
Country	:	US
Telephone Number	:	631-252-2820
Fax Number	:	631-225-1789

Authorized Official
Title or Position	:	OWNER
Name	:	DAISY TORRES
Credential	:	LCSW-R
Telephone Number	:	631-252-2820

Provider Enumeration Date	:	11/11/2017
Last Update Date	:	11/12/2019

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