Healthcare Provider Details

I. General information

NPI: 1083605760
Provider Name (Legal Business Name): LISA MARY ORTIGARA CREGO LCSW CEDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 HOLLYWOOD BLVD STE 2
HOLLYWOOD FL
33020-6605
US

IV. Provider business mailing address

2225 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3611
US

V. Phone/Fax

Practice location:
  • Phone: 954-927-5953
  • Fax:
Mailing address:
  • Phone: 954-927-5953
  • Fax: 954-962-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: