Provider Demographics
NPI:1376964965
Name:ORTIZ-SOBA, YACYRENIA (LMSW)
Entity Type:Individual
Prefix:
First Name:YACYRENIA
Middle Name:
Last Name:ORTIZ-SOBA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:YACYRENIA
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:74-09 37TH AVENUE, SUITE 315
Mailing Address - Street 2:WESTERN QUEENS CONSULTATION CENTER
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6300
Mailing Address - Country:US
Mailing Address - Phone:718-672-1705
Mailing Address - Fax:718-672-2027
Practice Address - Street 1:74-09 37TH AVENUE, SUITE 315
Practice Address - Street 2:WESTERN QUEENS CONSULTATION CENTER
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6300
Practice Address - Country:US
Practice Address - Phone:718-672-1705
Practice Address - Fax:718-672-2027
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8351573104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker