Provider Demographics
NPI:1043651250
Name:PORTILLA, VANESSA MARIA (MA)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARIA
Last Name:PORTILLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E2 JARD MARIBEL
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5603
Mailing Address - Country:US
Mailing Address - Phone:939-224-0214
Mailing Address - Fax:
Practice Address - Street 1:EDIFICO LA CURVA PROFESSIONAL PLAZA AVE MILITAR 3081
Practice Address - Street 2:SUITE 201
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-373-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3801103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty