Provider Demographics
NPI:1154441293
Name:ORTIZ-ROSA, MONA LISA (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:MONA LISA
Middle Name:
Last Name:ORTIZ-ROSA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MISS
Other - First Name:MONA
Other - Middle Name:LISA
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:32 W 37TH ST
Mailing Address - Street 2:#5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7477
Mailing Address - Country:US
Mailing Address - Phone:212-868-2427
Mailing Address - Fax:
Practice Address - Street 1:875 AVENUE OF THE AMERICAS
Practice Address - Street 2:SUITE 1810
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3507
Practice Address - Country:US
Practice Address - Phone:212-868-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03780511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN53561Medicare ID - Type Unspecified