Provider Demographics
NPI:1497571103
Name:PORTILLO, YOSSELIN ELIZABETH
Entity type:Individual
Prefix:
First Name:YOSSELIN
Middle Name:ELIZABETH
Last Name:PORTILLO
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 1:39 FRANCIS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4813
Mailing Address - Country:US
Mailing Address - Phone:857-234-1929
Mailing Address - Fax:
Practice Address - Street 1:260 MILTON ST STE 101
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2927
Practice Address - Country:US
Practice Address - Phone:781-344-3400
Practice Address - Fax:781-326-3400
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health