Active NPI
Staci Ortiz, PH.D.
- Clinical Child & Adolescent Psychologist
- Astoria, NY
National Provider Identifier
1457747495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 020775-1
- Practice address
- 2574 46TH St
Apt 2
Astoria, NY 11103-1107 - Phone
- (917) 302-5745
- NPI assigned
- Apr 7, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 020775-1 | NY | Primary |
Addresses
Primary practice location
2574 46TH St
Apt 2
Astoria, NY 11103-1107
Mailing address
2574 46TH St
Apt 2
Astoria, NY 11103-1107
Phone (917) 302-5745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020775-1 | NY | MD | Physical Therapist |
| 020775 | NY | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428364800000",
"number": "1457747495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2574 46TH ST",
"address_2": "APT 2",
"city": "ASTORIA",
"state": "NY",
"postal_code": "111031107",
"telephone_number": "917-302-5745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2574 46TH ST",
"address_2": "APT 2",
"city": "ASTORIA",
"state": "NY",
"postal_code": "111031107",
"telephone_number": "917-302-5745"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ORTIZ",
"first_name": "STACI",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-07",
"last_updated": "2015-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NY",
"license": "020775-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Astoria, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.