Healthcare Provider Details

I. General information

NPI: 1255125142
Provider Name (Legal Business Name): LUVETH ANDREA PORTILLO-CARBAJAL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 SANTA BARBARA RD
ELKRIDGE MD
21075-7500
US

IV. Provider business mailing address

6655 SANTA BARBARA RD
ELKRIDGE MD
21075-7500
US

V. Phone/Fax

Practice location:
  • Phone: 866-968-6342
  • Fax:
Mailing address:
  • Phone: 866-968-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number32727
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32727
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: