Provider Demographics
NPI:1891889697
Name:ORTIZ, BRUNILDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRUNILDA
Middle Name:
Last Name:ORTIZ
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 1:23003 GOOD DALE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7009
Mailing Address - Country:US
Mailing Address - Phone:713-851-8145
Mailing Address - Fax:281-821-2282
Practice Address - Street 1:525 N SAM HOUSTON PKWY E STE 370B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4016
Practice Address - Country:US
Practice Address - Phone:713-851-8145
Practice Address - Fax:281-821-2282
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37259104100000X, 171M00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263976S5TOtherMEDICARE PTAN GROUP
TX18020401Medicaid
TX18020401Medicaid