Provider Demographics
NPI:1184127318
Name:PORTMAN, PATRICK ORLO
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ORLO
Last Name:PORTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1141
Mailing Address - Country:US
Mailing Address - Phone:513-254-1300
Mailing Address - Fax:
Practice Address - Street 1:6722 STATE ROUTE 132
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9249
Practice Address - Country:US
Practice Address - Phone:513-575-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.166308101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)