Healthcare Provider Details

I. General information

NPI: 1316531965
Provider Name (Legal Business Name): CARA ORTEGA, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 CAMINO VERDE
MONTEZUMA NM
87731-2011
US

IV. Provider business mailing address

294 CAMINO VERDE
MONTEZUMA NM
87731-2011
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-5172
  • Fax:
Mailing address:
  • Phone: 505-557-5172
  • Fax:

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: CARA ORTEGA
Title or Position: PRESIDENT/CEO
Credential: LCSW
Phone: 505-557-5172