MEDICARE: LISA MARY ORTIGARA CREGO LCSW CEDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW5558	FL

General Provider Information

NPI Number	:	1083605760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARY ORTIGARA CREGO LCSW CEDS

Provider Business Mailing Address
First Line	:	2225 N UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3611
Country	:	US
Telephone Number	:	954-927-5953
Fax Number	:	954-962-5495

Provider Business Practice Location Address
First Line	:	2421 HOLLYWOOD BLVD STE 2
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6605
Country	:	US
Telephone Number	:	954-927-5953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/06/2026

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