Provider Demographics
NPI:1285995621
Name:PORTEE, SHATIERA MYESHA (LAC,NCC)
Entity type:Individual
Prefix:
First Name:SHATIERA
Middle Name:MYESHA
Last Name:PORTEE
Suffix:
Gender:F
Credentials:LAC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HOPE LN
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-7077
Mailing Address - Country:US
Mailing Address - Phone:732-222-2714
Mailing Address - Fax:
Practice Address - Street 1:19 HOPE LN
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-7077
Practice Address - Country:US
Practice Address - Phone:732-222-2714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health