Provider Demographics
NPI:1952436040
Name:BORTINGER, NANCY JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JANE
Last Name:BORTINGER
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 1:220 EMMETT PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2803
Mailing Address - Country:US
Mailing Address - Phone:201-670-9323
Mailing Address - Fax:
Practice Address - Street 1:220 EMMETT PL
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2803
Practice Address - Country:US
Practice Address - Phone:201-670-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ433688Medicare ID - Type Unspecified