Provider Demographics
NPI:1689126088
Name:ORTIZ PEREZ, MARIEMYR (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIEMYR
Middle Name:
Last Name:ORTIZ PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 AVE FD ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2804
Mailing Address - Country:US
Mailing Address - Phone:787-662-5245
Mailing Address - Fax:
Practice Address - Street 1:1215 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2804
Practice Address - Country:US
Practice Address - Phone:787-662-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR130631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical