Provider Demographics
NPI:1225011802
Name:PORTA, GEORGE RICHARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:RICHARD
Last Name:PORTA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SW 62ND AVE
Mailing Address - Street 2:SUITE 545
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-740-9261
Mailing Address - Fax:305-669-8890
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 545
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-740-9261
Practice Address - Fax:305-669-8890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2398Medicare ID - Type Unspecified