Provider Demographics
NPI:1699932988
Name:ORTIZ, NICOLE (LPC, LCADC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 FRANKLIN CORNER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2527
Mailing Address - Country:US
Mailing Address - Phone:732-859-0575
Mailing Address - Fax:
Practice Address - Street 1:134 FRANKLIN CORNER RD STE 201
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2527
Practice Address - Country:US
Practice Address - Phone:732-859-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-2652068OtherEIN