Provider Demographics
NPI:1982938056
Name:PORTUGAL, SONIA (LMSW)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:PORTUGAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 CRESCENT ST
Mailing Address - Street 2:APT. 3H
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2930
Mailing Address - Country:US
Mailing Address - Phone:718-956-8965
Mailing Address - Fax:
Practice Address - Street 1:274 W 145TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4122
Practice Address - Country:US
Practice Address - Phone:212-368-4100
Practice Address - Fax:212-281-5041
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0836861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical