Provider Demographics
NPI:1396610895
Name:PORTNOFF, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PORTNOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3138
Mailing Address - Country:US
Mailing Address - Phone:973-494-6655
Mailing Address - Fax:
Practice Address - Street 1:154 S LIVINGSTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3017
Practice Address - Country:US
Practice Address - Phone:973-494-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC065063001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical