Provider Demographics
NPI:1861554420
Name:ORTIZ, TIMOTHY (LCSW,CASAC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:LCSW,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 MILBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4933
Mailing Address - Country:US
Mailing Address - Phone:516-992-2832
Mailing Address - Fax:516-623-5553
Practice Address - Street 1:3228 MILBURN AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4933
Practice Address - Country:US
Practice Address - Phone:516-992-2832
Practice Address - Fax:516-623-5553
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0465051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical