Provider Demographics
NPI:1437344371
Name:ORTIZ, PEDRO (MSW, LCSW, LADC)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MSW, LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BROOKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6853
Mailing Address - Country:US
Mailing Address - Phone:860-268-1874
Mailing Address - Fax:
Practice Address - Street 1:3 BROOKVIEW CIR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6853
Practice Address - Country:US
Practice Address - Phone:860-268-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000851101YA0400X
CT0077471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)