Provider Demographics
NPI:1477083467
Name:ORTIZ, JAIME (LCSW)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4112
Mailing Address - Country:US
Mailing Address - Phone:830-778-3629
Mailing Address - Fax:830-778-3888
Practice Address - Street 1:108 PAGE AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4184
Practice Address - Country:US
Practice Address - Phone:830-778-3629
Practice Address - Fax:830-778-3888
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical