Provider Demographics
NPI:1902089998
Name:ORTIZ TERRON, RAQUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:ORTIZ TERRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3816
Mailing Address - Country:US
Mailing Address - Phone:201-338-2053
Mailing Address - Fax:718-222-4376
Practice Address - Street 1:10 HANOVER PL # PH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5840
Practice Address - Country:US
Practice Address - Phone:718-222-1518
Practice Address - Fax:718-222-4376
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0675801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical