Healthcare Provider Details

I. General information

NPI: 1134030935
Provider Name (Legal Business Name): PRISCILLA ORTIZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 400
FOREST HILLS NY
11375-7211
US

IV. Provider business mailing address

11835 QUEENS BLVD STE 400
FOREST HILLS NY
11375-7211
US

V. Phone/Fax

Practice location:
  • Phone: 914-279-8864
  • Fax: 877-929-2508
Mailing address:
  • Phone: 914-279-8864
  • Fax: 877-929-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: