Provider Demographics
NPI:1427073741
Name:PORTERFIELD-IZZO, PAULA (LMHC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:PORTERFIELD-IZZO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2794 LONG BOAT DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-6004
Mailing Address - Country:US
Mailing Address - Phone:904-955-2586
Mailing Address - Fax:
Practice Address - Street 1:2794 LONG BOAT DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-6004
Practice Address - Country:US
Practice Address - Phone:904-955-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3339101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor