=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629952502
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN AMBER REID-ORTIZ LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2025
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 607 N JEROME AVE
-----------------------------------------------------
City | MARGATE CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08402-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-822-1108
-----------------------------------------------------
Fax | 609-882-1108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 607 N JEROME AVE
-----------------------------------------------------
City | MARGATE CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08402-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-822-1108
-----------------------------------------------------
Fax | 609-882-1108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SL07198800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------