=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568303717
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSELIA ORTEGA, LICENSED CLINICAL SOCIAL WORKER, APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2026
-----------------------------------------------------
Last Update Date | 04/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 13TH ST STE B4
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95354-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-209-5470
-----------------------------------------------------
Fax | 209-414-3428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 615 13TH ST STE B4
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95354-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-209-5470
-----------------------------------------------------
Fax | 209-414-3428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | ROSELIA MELINA ORTEGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-209-5470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------