Provider Demographics
NPI:1366623399
Name:ORTIZ, JOHN B (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301579
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-0014
Mailing Address - Country:US
Mailing Address - Phone:857-209-4690
Mailing Address - Fax:
Practice Address - Street 1:115 GREENOUGH ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6199
Practice Address - Country:US
Practice Address - Phone:617-713-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2152461041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool