Provider Demographics
NPI:1114236775
Name:ORTIZ, MELISSA ANN (LPC)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ANN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MILLS ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4940
Mailing Address - Country:US
Mailing Address - Phone:203-535-5246
Mailing Address - Fax:
Practice Address - Street 1:62 MILLS ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4940
Practice Address - Country:US
Practice Address - Phone:203-535-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst