Provider Demographics
NPI:1639354814
Name:ORTIZ, ELIZABETH (LMHC)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 WORCESTER ST APT 102
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1358
Mailing Address - Country:US
Mailing Address - Phone:508-330-9027
Mailing Address - Fax:
Practice Address - Street 1:405 GROVE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1270
Practice Address - Country:US
Practice Address - Phone:508-330-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALMHC7306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health