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General NPI Number Information
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NPI Number | 1336062587
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Entity Type | Individual
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Provider Name | CHRISTA PORTE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 406 MAIMAI ST
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City | CHALAN PAGO
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State | GU
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Zip | 96910-5669
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Country | US
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Telephone | 671-475-7101
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4416
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City | YIGO
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State | GU
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Zip | 96929-4416
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Country | US
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Telephone | 725-895-5530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-E-049
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License Number State | GU
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