Provider Demographics
NPI:1477738540
Name:ORTIZ, ANGELA MARIAN (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIAN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1609
Mailing Address - Country:US
Mailing Address - Phone:917-597-6982
Mailing Address - Fax:
Practice Address - Street 1:5030 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1609
Practice Address - Country:US
Practice Address - Phone:917-597-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0761431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical