Provider Demographics
NPI:1659817641
Name:ORTIZ, JOAN (MS)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK PLACE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2332
Mailing Address - Country:US
Mailing Address - Phone:407-518-9505
Mailing Address - Fax:407-518-9507
Practice Address - Street 1:100 PARK PLACE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2332
Practice Address - Country:US
Practice Address - Phone:407-518-9505
Practice Address - Fax:407-518-9507
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker