Provider Demographics
NPI:1932609724
Name:CORTEZ, MARIE AC (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:AC
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ORCHARD HILL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3025
Mailing Address - Country:US
Mailing Address - Phone:860-490-8384
Mailing Address - Fax:
Practice Address - Street 1:240 ORCHARD HILL DR
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3025
Practice Address - Country:US
Practice Address - Phone:860-490-8384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0095971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty