Individual
PENNIE C ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
240 W MAIN ST, RIVERHEAD, NY 11901-2841
(631) 727-0710
Mailing address
9 ARTIST DR, MIDDLE ISLAND, NY 11953-1308
(631) 727-0710
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
9638
NY
Other
Enumeration date
03/11/2016
Last updated
03/11/2016
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