Provider Demographics
NPI:1922311216
Name:ORTIZ, MELISSA F (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:F
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 CAMPBELL ST
Mailing Address - Street 2:S110
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3256
Mailing Address - Country:US
Mailing Address - Phone:732-428-4465
Mailing Address - Fax:
Practice Address - Street 1:1470 CAMPBELL ST
Practice Address - Street 2:S110
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-3256
Practice Address - Country:US
Practice Address - Phone:732-428-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1640070103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool