Provider Demographics
NPI:1982212916
Name:ORTIZ, KHRYSTA G (MS, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:KHRYSTA
Middle Name:G
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:KHRYSTA
Other - Middle Name:G
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:229 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3243
Mailing Address - Country:US
Mailing Address - Phone:860-670-8966
Mailing Address - Fax:
Practice Address - Street 1:270 FARMINGTON AVE STE 264
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1953
Practice Address - Country:US
Practice Address - Phone:860-430-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-20-43250103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst