Provider Demographics
NPI:1659899524
Name:ORTIZ BORGES, NITZA DENISSE (LICSW)
Entity Type:Individual
Prefix:
First Name:NITZA
Middle Name:DENISSE
Last Name:ORTIZ BORGES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2729
Mailing Address - Country:US
Mailing Address - Phone:413-687-8552
Mailing Address - Fax:
Practice Address - Street 1:62 WARREN ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2729
Practice Address - Country:US
Practice Address - Phone:413-687-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001245431041C0700X
PR11952104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty