Provider Demographics
NPI:1063506103
Name:ORTOLF, DARCEY JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:DARCEY
Middle Name:JEAN
Last Name:ORTOLF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 SAW CREEK ESTATES
Mailing Address - Street 2:
Mailing Address - City:BUSHKILL
Mailing Address - State:PA
Mailing Address - Zip Code:18324
Mailing Address - Country:US
Mailing Address - Phone:570-588-0161
Mailing Address - Fax:570-588-4443
Practice Address - Street 1:3200 BRONX BOULEVARD
Practice Address - Street 2:PARKVIEW HOME FOR ADULTS
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-547-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02012480Medicaid
V101G1Medicare ID - Type Unspecified