Provider Demographics
NPI:1134175722
Name:ORTIZ ORTIZ, JOSE R (LCSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:ORTIZ ORTIZ
Suffix:
Gender:M
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:PO BOX 120184
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-0184
Mailing Address - Country:US
Mailing Address - Phone:718-643-0232
Mailing Address - Fax:718-596-6655
Practice Address - Street 1:10 HANOVER PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5840
Practice Address - Country:US
Practice Address - Phone:718-222-1518
Practice Address - Fax:718-222-4376
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0723961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical