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General NPI Number Information
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NPI Number | 1427958198
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Entity Type | Individual
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Provider Name | THERESA PORTELLO LAC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 114 ROUTE 34
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City | MATAWAN
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State | NJ
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Zip | 07747-2132
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Country | US
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Telephone | 732-696-8162
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Fax |
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Provider Business Mailing Address
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Address Line | 114 ROUTE 34
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City | MATAWAN
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State | NJ
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Zip | 07747-2132
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Country | US
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Telephone | 732-639-1123
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37AC01009800
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License Number State | NJ
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