Provider Demographics
NPI:1023680444
Name:BORTZ, LINDSAY LOUISE (LMSW)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:LOUISE
Last Name:BORTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:LOUISE
Other - Last Name:BORTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:768 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2006
Mailing Address - Country:US
Mailing Address - Phone:716-882-3151
Mailing Address - Fax:
Practice Address - Street 1:1050 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2001
Practice Address - Country:US
Practice Address - Phone:716-710-4393
Practice Address - Fax:716-856-5614
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY708813695171M00000X
NY72-P126814-01101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101Y00000XMedicaid
NY171M00000XOtherTAXONOMY CODE