Provider Demographics
NPI:1114332970
Name:ORTIZ, SHAYLEEN MARIA (LMHC)
Entity Type:Individual
Prefix:
First Name:SHAYLEEN
Middle Name:MARIA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHAYLEEN
Other - Middle Name:MARIA
Other - Last Name:PARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:26 COURT ST BROOKLYN SUITE #1620
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:347-764-0259
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST BROOKLYN SUITE #1620
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:347-764-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor