Healthcare Provider Details

I. General information

NPI: 1700761178
Provider Name (Legal Business Name): JESSICA C ORTIZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 N BLACK HORSE PIKE STE 8
WILLIAMSTOWN NJ
08094-2840
US

IV. Provider business mailing address

450 WINDSOR DR
BELLMAWR NJ
08031
US

V. Phone/Fax

Practice location:
  • Phone: 877-587-4092
  • Fax:
Mailing address:
  • Phone: 609-424-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06282200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00390500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: