Provider Demographics
NPI:1053849737
Name:ORTIZ, GLENIS CAROLINA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:GLENIS
Middle Name:CAROLINA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 PALM PLACE DR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3952
Mailing Address - Country:US
Mailing Address - Phone:862-944-2274
Mailing Address - Fax:
Practice Address - Street 1:1236 PALM PLACE DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3952
Practice Address - Country:US
Practice Address - Phone:862-944-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty