Healthcare Provider Details

I. General information

NPI: 1962132068
Provider Name (Legal Business Name): CRISTINA ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 WYOMING AVE
KINGSTON PA
18704-3603
US

IV. Provider business mailing address

470 WYOMING AVE
KINGSTON PA
18704-3603
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-8434
  • Fax: 570-288-1084
Mailing address:
  • Phone: 570-342-8434
  • Fax: 570-288-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025753
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: