Provider Demographics
NPI:1629360136
Name:ORTIZ, MONICA ALICIA (LMSW)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ALICIA
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 1:812 E. JOLLY ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6821
Mailing Address - Country:US
Mailing Address - Phone:517-346-8223
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:812 E. JOLLY ROAD
Practice Address - Street 2:SUITE 216
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-346-9608
Practice Address - Fax:517-346-8291
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010883001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical