Provider Demographics
NPI:1598990871
Name:ORTEGA, EDWIN (CADC)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1512
Mailing Address - Country:US
Mailing Address - Phone:203-346-6287
Mailing Address - Fax:203-597-5459
Practice Address - Street 1:26 N ELM ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1512
Practice Address - Country:US
Practice Address - Phone:203-346-6287
Practice Address - Fax:203-597-5459
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)