Healthcare Provider Details

I. General information

NPI: 1710367149
Provider Name (Legal Business Name): DIANA AURORA PORTILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RADISSON PLZ FL 8
NEW ROCHELLE NY
10801-5766
US

IV. Provider business mailing address

42 BROAD ST W APT 617
MOUNT VERNON NY
10552-2172
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax:
Mailing address:
  • Phone: 347-585-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number087234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: