Provider Demographics
NPI:1699984716
Name:ORTIZ, JEANETTE (AA,LCDP, ACDP,RCS)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:AA,LCDP, ACDP,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 JOHNNY CAKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5674
Mailing Address - Country:US
Mailing Address - Phone:401-846-1213
Mailing Address - Fax:401-848-9157
Practice Address - Street 1:127 JOHNNY CAKE HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5674
Practice Address - Country:US
Practice Address - Phone:401-846-1213
Practice Address - Fax:401-848-9157
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00033101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI409686OtherBCBS BL CHIP
RI7891442OtherAETNA
RI410887OtherBCBS BL CHIP
RI1022660OtherBEACON-NH
RI30774-5OtherBCBS
RI6997-7OtherBCBS
RIA2833203OtherOXFORD HEALTH
RI253474OtherMAGELLAN
RI5079653OtherUNITED HEALTH
RI008740 A005204OtherVALUE OPTIONS
RICH-04437Medicaid