Provider Demographics
NPI:1437882628
Name:PORTILLO, SHARON (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 FELLSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-6006
Mailing Address - Country:US
Mailing Address - Phone:409-540-2055
Mailing Address - Fax:
Practice Address - Street 1:890 SIERRA DR
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5607
Practice Address - Country:US
Practice Address - Phone:409-540-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical