Provider Demographics
NPI:1659971919
Name:ORTIZ, ERICA DENISE (LCSW, IMH-E III)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DENISE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LCSW, IMH-E III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 CASA BLANCA NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3190
Mailing Address - Country:US
Mailing Address - Phone:505-363-7495
Mailing Address - Fax:505-554-3435
Practice Address - Street 1:6212 CASA BLANCA NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3190
Practice Address - Country:US
Practice Address - Phone:505-363-7495
Practice Address - Fax:505-554-4343
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-105241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87103567Medicaid