Basic Information
| Provider Information | |||||||||
| NPI: | 1760876536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | MARILUZ | ||||||||
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| Credential: | SW,MCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | VILLA SAN ANDRES # 349 | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006805704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872652300 | ||||||||
| FaxNumber: | 7878311714 | ||||||||
| Practice Location | |||||||||
| Address1: | SANTANDER SECURITIES PLAZA HOSTOS #349 | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872652300 | ||||||||
| FaxNumber: | 7878311714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2015 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1858 | PR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 8144 | PR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.