Provider Demographics
NPI:1992912539
Name:ORTIZ REA, CARLOS (LMHC)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:ORTIZ REA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 FREDERICK DOUGLASS BLVD
Mailing Address - Street 2:7F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6175
Mailing Address - Country:US
Mailing Address - Phone:212-665-0285
Mailing Address - Fax:212-665-4912
Practice Address - Street 1:2235 FREDERICK DOUGLASS BLVD
Practice Address - Street 2:7F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6175
Practice Address - Country:US
Practice Address - Phone:212-665-0285
Practice Address - Fax:212-665-4912
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002709101YM0800X
NY101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002709OtherMENTAL HEALTH COUNSELOR