Provider Demographics
NPI:1760876536
Name:ORTIZ, MARILUZ (SW,MCMHC)
Entity Type:Individual
Prefix:
First Name:MARILUZ
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:SW,MCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA SAN ANDRES # 349
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5704
Mailing Address - Country:US
Mailing Address - Phone:787-265-2300
Mailing Address - Fax:787-831-1714
Practice Address - Street 1:SANTANDER SECURITIES PLAZA HOSTOS #349
Practice Address - Street 2:SUITE 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-2300
Practice Address - Fax:787-831-1714
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1858101YM0800X
PR81441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health