Provider Demographics
NPI:1407476302
Name:PORTALE, JULIA D (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:D
Last Name:PORTALE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6101
Mailing Address - Country:US
Mailing Address - Phone:203-273-4645
Mailing Address - Fax:
Practice Address - Street 1:61 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-6101
Practice Address - Country:US
Practice Address - Phone:203-273-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3242104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3242OtherLMSW