Individual
STACI ORTIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2574 46TH ST, APT 2, ASTORIA, NY 11103-1107
(917) 302-5745
Mailing address
2574 46TH ST, APT 2, ASTORIA, NY 11103-1107
(917) 302-5745
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
020775-1
NY
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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