Healthcare Provider Details

I. General information

NPI: 1568303717
Provider Name (Legal Business Name): ROSELIA ORTEGA, LICENSED CLINICAL SOCIAL WORKER, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 13TH ST STE B4
MODESTO CA
95354-2456
US

IV. Provider business mailing address

615 13TH ST STE B4
MODESTO CA
95354-2456
US

V. Phone/Fax

Practice location:
  • Phone: 209-209-5470
  • Fax: 209-414-3428
Mailing address:
  • Phone: 209-209-5470
  • Fax: 209-414-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROSELIA MELINA ORTEGA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 209-209-5470