Provider Demographics
NPI:1326194457
Name:ORTIZ, LYNNE ELAINE SR (LISW)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:ELAINE
Last Name:ORTIZ
Suffix:SR
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 ESTHER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3653
Mailing Address - Country:US
Mailing Address - Phone:505-299-8606
Mailing Address - Fax:
Practice Address - Street 1:6433 ESTHER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3653
Practice Address - Country:US
Practice Address - Phone:505-299-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-27441041C0700X
NM2733121041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ9177Medicaid