Provider Demographics
NPI:1386863843
Name:ORTIZ, CARLA KRISTINE (LISW)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:KRISTINE
Last Name:ORTIZ
Suffix:
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 1:1700 LOMAS BLVD NE
Mailing Address - Street 2:1200
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3835
Mailing Address - Country:US
Mailing Address - Phone:505-272-6812
Mailing Address - Fax:
Practice Address - Street 1:625 SILVER AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3123
Practice Address - Country:US
Practice Address - Phone:505-345-4286
Practice Address - Fax:505-341-0318
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-06569104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker