Provider Demographics
NPI:1720211683
Name:ORTEGA, LOUISE GARZA (LBSW)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:GARZA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-0673
Mailing Address - Country:US
Mailing Address - Phone:575-388-2414
Mailing Address - Fax:575-388-2457
Practice Address - Street 1:515 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4900
Practice Address - Country:US
Practice Address - Phone:575-388-2414
Practice Address - Fax:575-388-2457
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-06749104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker