Provider Demographics
NPI:1669990156
Name:ORTA, CYNTHIA MAIORINO (CACI)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MAIORINO
Last Name:ORTA
Suffix:
Gender:F
Credentials:CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15954 JACKSON CREEK PKWY # B423
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8532
Mailing Address - Country:US
Mailing Address - Phone:719-460-3122
Mailing Address - Fax:
Practice Address - Street 1:1824 WOODMOOR DR STE 101
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9097
Practice Address - Country:US
Practice Address - Phone:719-445-9330
Practice Address - Fax:719-445-9330
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACA.0007583101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)