Provider Demographics
NPI:1396805412
Name:ORT, DEBRA ANN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:ORT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BAYLEAF CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-1814
Mailing Address - Country:US
Mailing Address - Phone:843-291-8900
Mailing Address - Fax:
Practice Address - Street 1:145 CEDAR BREEZE CTR
Practice Address - Street 2:
Practice Address - City:GLENBURN
Practice Address - State:ME
Practice Address - Zip Code:04401-1729
Practice Address - Country:US
Practice Address - Phone:207-217-6551
Practice Address - Fax:207-217-6552
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081165363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2218713OtherCIGNA
ME432811599Medicaid
ME405721OtherMHN-MANAGED HEALTH NETWORKS
ME4346-07OtherPACIFICARE BEHAVIORAL HEALTH
ME200263OtherANTHEM
ME9289053OtherAETNA
ME432811599Medicaid