Provider Demographics
NPI:1457405748
Name:ORTIZ, LAURA DAMARIS (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DAMARIS
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4K28 COLINAS DE FAIRVIEW
Mailing Address - Street 2:CALLE 214 #
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-755-0811
Mailing Address - Fax:787-276-2853
Practice Address - Street 1:214 STREET # 4K28 COLINAS DE FAIRVIEW
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-755-0811
Practice Address - Fax:787-276-2853
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2099OtherPROFESSIONAL LICENSE