Provider Demographics
NPI:1679703714
Name:ORTIZ, YOLANDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 BOTTLEBRUSH DR NE
Mailing Address - Street 2:STE 5
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3138
Mailing Address - Country:US
Mailing Address - Phone:321-421-6992
Mailing Address - Fax:321-421-6993
Practice Address - Street 1:1520 BOTTLEBRUSH DR NE
Practice Address - Street 2:STE 5
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3138
Practice Address - Country:US
Practice Address - Phone:321-421-6992
Practice Address - Fax:321-421-6993
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 121931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical