Provider Demographics
NPI:1760043004
Name:ORTEGA, SOPHIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:ORTEGA
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 1:2225 COUNTY ROAD 90 STE 201D
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5133
Mailing Address - Country:US
Mailing Address - Phone:832-481-2832
Mailing Address - Fax:
Practice Address - Street 1:2225 COUNTY ROAD 90 STE 201D
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5133
Practice Address - Country:US
Practice Address - Phone:832-481-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX526731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical