Provider Demographics
NPI:1710226519
Name:ORTIZ, JUAN RAMON (CASAC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:RAMON
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1508
Mailing Address - Country:US
Mailing Address - Phone:914-941-1628
Mailing Address - Fax:
Practice Address - Street 1:1 GORDON AVE
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1508
Practice Address - Country:US
Practice Address - Phone:914-941-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17848101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)