Provider Demographics
NPI:1164589677
Name:LA PORTA, LILLY S (MD)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:S
Last Name:LA PORTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3440 MARKET ST
Mailing Address - Street 2:FLOOR 2 BEHAVIORAL HEALTH CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3325
Mailing Address - Country:US
Mailing Address - Phone:215-590-7296
Mailing Address - Fax:215-590-7350
Practice Address - Street 1:3440 MARKET ST
Practice Address - Street 2:FLOOR 2 BEHAVIORAL HEALTH CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3325
Practice Address - Country:US
Practice Address - Phone:215-590-7296
Practice Address - Fax:215-590-7350
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-08-17
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Provider Licenses
StateLicense IDTaxonomies
PAMT1881342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry