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General NPI Number Information
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NPI Number | 1144524984
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Entity Type | Individual
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Provider Name | JESSICA NICOLE CORTEZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 1086 ORNDORF DR
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City | BRIGHTON
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State | MI
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Zip | 48116-2308
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Country | US
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Telephone | 517-256-0896
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Fax | 517-655-3738
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Provider Business Mailing Address
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Address Line | 1851 ROSEMONT RD
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City | BERKLEY
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State | MI
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Zip | 48072-1845
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Country | US
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Telephone | 517-256-0896
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Fax | 517-655-3738
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801093949
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MI
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