Provider Demographics
NPI:1386324663
Name:JILL PORTARO, LCSW LLC
Entity type:Organization
Organization Name:JILL PORTARO, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTARO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-809-5103
Mailing Address - Street 1:415 STATE ROUTE 34 STE 203
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2526
Mailing Address - Country:US
Mailing Address - Phone:908-809-5103
Mailing Address - Fax:
Practice Address - Street 1:415 STATE ROUTE 34 STE 203
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2526
Practice Address - Country:US
Practice Address - Phone:908-809-5103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)