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General NPI Number Information
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NPI Number | 1215255625
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Entity Type | Organization
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Legal Business Name | LINNAR ORTALAN, LCSW, PC
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 4150 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312
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Country | US
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Telephone | 718-608-5919
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Fax |
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Provider Business Mailing Address
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Address Line | 83 PEMBERTON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10308
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Country | US
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Telephone | 718-608-5919
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Fax |
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Authorized Official
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Title or Position | OWNER OF THE CORPORATION
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Name | MS. LINNAR ORTALAN
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Credential | LCSW-R
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Telephone | 718-608-5908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R037127
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License Number State | NY
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