1114332970 NPI number — SHAYLEEN MARIA ORTIZ L.M.H.C

Table of content: SHAYLEEN MARIA ORTIZ L.M.H.C (NPI 1114332970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114332970 NPI number — SHAYLEEN MARIA ORTIZ L.M.H.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ
Provider First Name:
SHAYLEEN
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.H.C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARRA
Provider Other First Name:
SHAYLEEN
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.H.C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114332970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 COURT ST BROOKLYN SUITE #1620
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-764-0259
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 COURT ST BROOKLYN SUITE #1620
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-764-0259
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)