Provider Demographics
NPI:1285302877
Name:PORTUESI, HALEY (MSW, LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:
Last Name:PORTUESI
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 BACK BAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-8340
Mailing Address - Country:US
Mailing Address - Phone:301-305-5058
Mailing Address - Fax:
Practice Address - Street 1:394 BACK BAY
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-8340
Practice Address - Country:US
Practice Address - Phone:301-305-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0161901041C0700X
WVDP009456751041C0700X
MD242621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical