Provider Demographics
NPI:1922887348
Name:PORTO, JOANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:PORTO
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 1:3904 SANDPIPER CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0225
Mailing Address - Country:US
Mailing Address - Phone:209-404-2129
Mailing Address - Fax:
Practice Address - Street 1:3904 SANDPIPER CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0225
Practice Address - Country:US
Practice Address - Phone:209-404-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW803701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical