Provider Demographics
NPI:1811327547
Name:ORTIZ, ROSA (MSW, QMHP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 N 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4128
Mailing Address - Country:US
Mailing Address - Phone:773-983-1928
Mailing Address - Fax:
Practice Address - Street 1:1709 N 75TH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4128
Practice Address - Country:US
Practice Address - Phone:773-983-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical