Provider Demographics
NPI:1508696329
Name:PORTILLO, RICHARD ANTHONY II (CT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:PORTILLO
Suffix:II
Gender:M
Credentials:CT
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:299 CRAMER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2586
Mailing Address - Country:US
Mailing Address - Phone:614-889-5722
Mailing Address - Fax:614-889-9335
Practice Address - Street 1:299 CRAMER CREEK CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2586
Practice Address - Country:US
Practice Address - Phone:614-889-5722
Practice Address - Fax:614-889-9335
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional