| Doctor Name: | MR. JUAN CARLOS ORTEGA |
| NPI Number: | 1053655159 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 450953 |
| Business Practice Address: | 800 Cummings Ctr Suite 360 U Beverly, MA - 019156175 |
| Business Phone Number: | 9782011066 |
| Business Fax Number: | |
| Mailing Address: | 800 Cummings Ctr, Suite 360 U BEVERLY |
| State: | MA |
| Postal Code: | 019156175 |
| Phone Number: | 9782011066 |
| Fax Number: | |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 11/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 450953 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |