Provider Demographics
NPI:1083463509
Name:ORTIZ MIRANDA, CARMEN BELISA (MSW, EDD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:BELISA
Last Name:ORTIZ MIRANDA
Suffix:
Gender:F
Credentials:MSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30288
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-1288
Mailing Address - Country:US
Mailing Address - Phone:787-405-0803
Mailing Address - Fax:
Practice Address - Street 1:160 AVENIDA CARLOS E CHARDON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-405-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8520104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker