Provider Demographics
NPI:1497029797
Name:PORTAS, GABRIELA (MA, ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:PORTAS
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E 63RD ST
Mailing Address - Street 2:W11E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7804
Mailing Address - Country:US
Mailing Address - Phone:646-964-5512
Mailing Address - Fax:626-739-7781
Practice Address - Street 1:425 E 63RD ST
Practice Address - Street 2:W11E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7804
Practice Address - Country:US
Practice Address - Phone:646-964-5512
Practice Address - Fax:626-739-7781
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-04
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001343-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health