Provider Demographics
NPI:1063614899
Name:ORTEGA, SHELBY (PHD)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CHURCH ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3737
Mailing Address - Country:US
Mailing Address - Phone:617-453-8501
Mailing Address - Fax:
Practice Address - Street 1:32 CHURCH ST STE 2C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3737
Practice Address - Country:US
Practice Address - Phone:617-453-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical