Provider Demographics
NPI:1083971055
Name:ORTEGA, LAURA ROSA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROSA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 W 38TH PL
Mailing Address - Street 2:1207
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7077
Mailing Address - Country:US
Mailing Address - Phone:786-566-3713
Mailing Address - Fax:
Practice Address - Street 1:1711 W 38TH PL
Practice Address - Street 2:1207
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7077
Practice Address - Country:US
Practice Address - Phone:786-566-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2451106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist