MEDICARE: MS. LUVETH ANDREA PORTILLO-CARBAJAL LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	32727	MD
2	1041C0700X	Clinical Social Worker	32727	MD

General Provider Information

NPI Number	:	1255125142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUVETH ANDREA PORTILLO-CARBAJAL LMSW

Provider Business Mailing Address
First Line	:	6655 SANTA BARBARA RD
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-7500
Country	:	US
Telephone Number	:	866-968-6342
Fax Number	:

Provider Business Practice Location Address
First Line	:	6655 SANTA BARBARA RD
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-7500
Country	:	US
Telephone Number	:	866-968-6342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	05/19/2026

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