Provider Demographics
NPI:1235547357
Name:ORTIZ, ANGEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 W SWANZEY RD
Mailing Address - Street 2:
Mailing Address - City:SWANZEY
Mailing Address - State:NH
Mailing Address - Zip Code:03446-3219
Mailing Address - Country:US
Mailing Address - Phone:603-358-0070
Mailing Address - Fax:603-358-0070
Practice Address - Street 1:1076 W SWANZEY RD
Practice Address - Street 2:
Practice Address - City:SWANZEY
Practice Address - State:NH
Practice Address - Zip Code:03446-3219
Practice Address - Country:US
Practice Address - Phone:603-358-0070
Practice Address - Fax:603-358-0070
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0866101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)