MEDICARE: MS. KRISTIN ORTIZ LMSW

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	104100000X	Social Worker	113162	NY

General Provider Information

NPI Number	:	1851965974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN ORTIZ LMSW

Provider Business Mailing Address
First Line	:	960 WILLOUGHBY AVE APT 4O
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3491
Country	:	US
Telephone Number	:	570-466-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 W 72ND ST RM 505
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-3250
Country	:	US
Telephone Number	:	917-497-2760
Fax Number	:

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

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	07/12/2021

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