Provider Demographics
NPI:1215255625
Name:LINNAR ORTALAN, LCSW, PC
Entity type:Organization
Organization Name:LINNAR ORTALAN, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE CORPORATION
Authorized Official - Prefix:MS
Authorized Official - First Name:LINNAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTALAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:718-608-5908
Mailing Address - Street 1:83 PEMBERTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308
Mailing Address - Country:US
Mailing Address - Phone:718-608-5919
Mailing Address - Fax:
Practice Address - Street 1:4150 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-608-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0371271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty