MEDICARE: JABNEEL TORRES MS, CAP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	IMH16466	FL

General Provider Information

NPI Number	:	1770984296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JABNEEL TORRES MS, CAP

Provider Business Mailing Address
First Line	:	8359 BEACON BLVD STE 312
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3062
Country	:	US
Telephone Number	:	239-747-5791
Fax Number	:

Provider Business Practice Location Address
First Line	:	8359 BEACON BLVD STE 312
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3062
Country	:	US
Telephone Number	:	239-747-5701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	10/27/2017

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