Provider Demographics
NPI:1548749161
Name:TORTU, PATRICIA LANI (RBT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LANI
Last Name:TORTU
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707A S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1301
Mailing Address - Country:US
Mailing Address - Phone:856-213-8378
Mailing Address - Fax:
Practice Address - Street 1:1256 MARLKRESS RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2626
Practice Address - Country:US
Practice Address - Phone:856-888-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-17-30893106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician