Provider Demographics
NPI:1003363664
Name:ORTIZ, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ERSKINE PLACE
Mailing Address - Street 2:APT5-D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475
Mailing Address - Country:US
Mailing Address - Phone:646-546-9118
Mailing Address - Fax:
Practice Address - Street 1:100 ERSKINE PL
Practice Address - Street 2:APT5-D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5732
Practice Address - Country:US
Practice Address - Phone:646-546-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical