Provider Demographics
NPI:1235450057
Name:ORTIZ, SHARON LISBETTE (PHD CPL)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LISBETTE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PHD CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SS 10 CALLE ALMENDRO
Mailing Address - Street 2:QUINTAS DE DORADO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4745
Mailing Address - Country:US
Mailing Address - Phone:787-528-4182
Mailing Address - Fax:
Practice Address - Street 1:SS 10 CALLE ALMENDRO
Practice Address - Street 2:QUINTAS DE DORADO
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4745
Practice Address - Country:US
Practice Address - Phone:787-528-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0870OtherDEPARTAMENTO DE SALUD DE PR