Provider Demographics
NPI:1376282210
Name:ORTIZ, JANESSA E (MSW, LSW)
Entity Type:Individual
Prefix:MISS
First Name:JANESSA
Middle Name:E
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3328
Mailing Address - Country:US
Mailing Address - Phone:732-979-0497
Mailing Address - Fax:
Practice Address - Street 1:252 FULTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3328
Practice Address - Country:US
Practice Address - Phone:732-979-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL0651500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker