Basic Information
Provider Information
NPI: 1003297870
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORTIZ
FirstName: GABRIELA
MiddleName: BEATRIZ
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 65 HIGHLAND STREET
Address2:  
City: PATERSON
State: NJ
PostalCode: 07524
CountryCode: US
TelephoneNumber: 9732342919
FaxNumber:  
Practice Location
Address1: 770 WOODLAND ROAD - SUITE 35
Address2:  
City: MT. HOLLY
State: NJ
PostalCode: 08060
CountryCode: US
TelephoneNumber: 6092675928
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/17/2015
LastUpdateDate: 06/17/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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