Healthcare Provider Details

I. General information

NPI: 1164184552
Provider Name (Legal Business Name): MARIA E ORTIZ M.A., LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 10TH AVE
NEW YORK NY
10036-2904
US

IV. Provider business mailing address

645 10TH AVE
NEW YORK NY
10036-2904
US

V. Phone/Fax

Practice location:
  • Phone: 212-265-4500
  • Fax:
Mailing address:
  • Phone: 929-376-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number094537
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: