Organization
GENIE PORTILLO LCSW-R, CASC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE PORTILLO LCSW-R (OWNER)
(631) 998-4644
Entity
Organization
Contact information
Practice address
16 LIBRARY AVE STE B, WESTHAMPTON BEACH, NY 11978-2664
(631) 998-4644
Mailing address
16 LIBRARY AVE STE B, WESTHAMPTON BEACH, NY 11978-2664
(631) 998-4644
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/21/2021
Last updated
04/21/2021
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