MEDICARE: CECILY PORTILLO PSYCHOLOGIST PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1982544383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CECILY PORTILLO PSYCHOLOGIST PLLC

Provider Business Mailing Address
First Line	:	222 LINCOLN AVE
Second Line	:
City	:	MINEOLA
State	:	NY
Zip	:	11501-2543
Country	:	US
Telephone Number	:	631-877-9735
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 7TH ST STE 200
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5747
Country	:	US
Telephone Number	:	631-319-0942
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER/PSYCHOLOGIST
Name	:	DR. CECILY PORTILLO
Credential	:	PHD
Telephone Number	:	631-877-9735

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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