Provider Demographics
NPI:1881936573
Name:ORTLIEB, JENNIFER DEBARTOLO (MA, RMHCI)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DEBARTOLO
Last Name:ORTLIEB
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 DOUGLAS AVE. SUITE, 208
Mailing Address - Street 2:
Mailing Address - City:ALMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:407-830-6412
Mailing Address - Fax:407-830-8413
Practice Address - Street 1:801 DOUGLAS AVENUE SUITE, 208
Practice Address - Street 2:
Practice Address - City:ALMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:407-830-8413
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11092104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker