Provider Demographics
NPI:1700910031
Name:ORTELL, ERICA LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:ORTELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CORAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4822
Mailing Address - Country:US
Mailing Address - Phone:401-714-7943
Mailing Address - Fax:
Practice Address - Street 1:2444 E MAIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4025
Practice Address - Country:US
Practice Address - Phone:401-683-6210
Practice Address - Fax:401-683-6212
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW014761041C0700X
MA10322701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI265854OtherBCBS OF RI AND BLUECHIP
RI6277241OtherUNITED BEHAVIORAL HEALTH
RI270651OtherMENTAL HEALTH NETWORK
RI1037470OtherNEIGHBORHOOD HEALTH PLAN