Provider Demographics
NPI:1962621920
Name:ORTEGA, KORINA MARIA (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:KORINA
Middle Name:MARIA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:KORINA
Other - Middle Name:MARIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, PHD
Mailing Address - Street 1:PSC 10
Mailing Address - Street 2:BOX 521
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09142
Mailing Address - Country:US
Mailing Address - Phone:49630-292-3583
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER, SOCIAL WORK SERVICES
Practice Address - Street 2:CMR 402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:49637-186-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
VT089.00485331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical