Provider Demographics
NPI:1093826059
Name:ORTIZ, ROSE NEREYDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:NEREYDA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 WEST 43RD ST
Mailing Address - Street 2:SUITE 1 GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036
Mailing Address - Country:US
Mailing Address - Phone:917-554-8588
Mailing Address - Fax:212-262-2392
Practice Address - Street 1:439 WEST 43RD ST
Practice Address - Street 2:SUITE 1 GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:917-554-8588
Practice Address - Fax:212-262-2392
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069947-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical