Healthcare Provider Details

I. General information

NPI: 1164541363
Provider Name (Legal Business Name): NORMA E. ORTEGA PH.D., L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 6TH AVE
BROOKLYN NY
11220-4004
US

IV. Provider business mailing address

6025 6TH AVE
BROOKLYN NY
11220-4004
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002418
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: