Provider Demographics
NPI:1407935992
Name:LOVITZ-ORTEGA, REBECCA (MSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LOVITZ-ORTEGA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-1349
Mailing Address - Country:US
Mailing Address - Phone:617-721-4567
Mailing Address - Fax:
Practice Address - Street 1:9 GETCHELL ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6109
Practice Address - Country:US
Practice Address - Phone:207-228-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MELC145991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical