Provider Demographics
NPI:1285138859
Name:ORTIZ, ILEA Y (MSW)
Entity type:Individual
Prefix:MRS
First Name:ILEA
Middle Name:Y
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BIELLA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2014
Mailing Address - Country:US
Mailing Address - Phone:413-277-8080
Mailing Address - Fax:
Practice Address - Street 1:95 FRANK B MURRAY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1106
Practice Address - Country:US
Practice Address - Phone:413-285-8586
Practice Address - Fax:413-273-1490
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty