Provider Demographics
NPI:1710367149
Name:PORTILLO, DIANA AURORA (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:AURORA
Last Name:PORTILLO
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 1:306 E MOSHOLU PKWY S
Mailing Address - Street 2:1E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1713
Mailing Address - Country:US
Mailing Address - Phone:347-585-8444
Mailing Address - Fax:
Practice Address - Street 1:1 HOYT ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5809
Practice Address - Country:US
Practice Address - Phone:718-802-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093310-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker