Doctor Name: | MS. GENIE M. PORTILLO |
NPI Number: | 1215018007 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSWR |
License Number: | R065271-1 |
Business Practice Address: | 16 Library Ave Suite B Westhampton Beach, NY - 119782664 |
Business Phone Number: | 6319984644 |
Business Fax Number: | 6319984645 |
Mailing Address: | 16 Library Ave, Suite B WESTHAMPTON BEACH |
State: | NY |
Postal Code: | 119782664 |
Phone Number: | 6319984644 |
Fax Number: | 6319984645 |
NPI Enumeration Date: | 10/18/2006 |
NPI Last Update Date: | 03/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | R065271-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |