Provider Demographics
NPI:1992368302
Name:ORTIZ, TAYLOR (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MARC DR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5708
Mailing Address - Country:US
Mailing Address - Phone:203-631-9061
Mailing Address - Fax:
Practice Address - Street 1:120 WEBSTER SQUARE RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2329
Practice Address - Country:US
Practice Address - Phone:860-420-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT510103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst