Provider Demographics
NPI:1043102874
Name:ORTIZ, KRYSTAL (LMHC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 65TH ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2824
Mailing Address - Country:US
Mailing Address - Phone:929-378-5005
Mailing Address - Fax:
Practice Address - Street 1:5731 65TH ST
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2824
Practice Address - Country:US
Practice Address - Phone:929-378-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health