Individual
KIMBERLY PORTUGAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, MPH
Contact information
Practice address
1155 S POWER RD STE 249, MESA, AZ 85206-3715
(747) 333-2460
Mailing address
10313 E THORNTON AVE, MESA, AZ 85212-8355
(949) 291-1868
(310) 818-5592
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
19692
CA
1041C0700X
Clinical Social Worker
Primary
LCSW18454
AZ
Other
Enumeration date
10/10/2019
Last updated
09/17/2021
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