Provider Demographics
NPI:1538149547
Name:ORTIZ, MARIE DELIZE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:DELIZE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:452 AVE PONCE DE LEON
Mailing Address - Street 2:EDI. ASOC. DE MAESTROS, SUITE 402
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3490
Mailing Address - Country:US
Mailing Address - Phone:787-767-6722
Mailing Address - Fax:787-753-0434
Practice Address - Street 1:452 AVE PONCE DE LEON
Practice Address - Street 2:EDI. ASOC. DE MAESTROS, SUITE 402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3490
Practice Address - Country:US
Practice Address - Phone:787-767-6722
Practice Address - Fax:787-753-0434
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical