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General NPI Number Information
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NPI Number | 1366148884
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Entity Type | Individual
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Provider Name | ALEXANDER JOSE PORTILLO LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 742 JAMES ST
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City | SYRACUSE
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State | NY
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Zip | 13203-2017
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Country | US
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Telephone | 315-703-2804
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Fax |
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Provider Business Mailing Address
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Address Line | 890 SEVENTH NORTH ST STE 200
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City | LIVERPOOL
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State | NY
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Zip | 13088-4980
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Country | US
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Telephone |
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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 | 098994
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License Number State | NY
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