Healthcare Provider Details

I. General information

NPI: 1245141639
Provider Name (Legal Business Name): LUCELY ORTIZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BRUCE PL UNIT 2
LYNN MA
01902-2313
US

IV. Provider business mailing address

24 BRUCE PL UNIT 2
LYNN MA
01902-2313
US

V. Phone/Fax

Practice location:
  • Phone: 339-338-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2141412
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: