Provider Demographics
NPI:1639516784
Name:ORTEGA PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:ORTEGA PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:347-689-9914
Mailing Address - Street 1:26 COURT ST
Mailing Address - Street 2:SUITE 1711
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-0103
Mailing Address - Country:US
Mailing Address - Phone:347-689-9914
Mailing Address - Fax:815-301-9247
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 1711
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:347-689-9914
Practice Address - Fax:815-301-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018373103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty