MEDICARE: SILVIA PORTILLO

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	0701013095	VA

General Provider Information

NPI Number	:	1427827021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SILVIA PORTILLO

Provider Business Mailing Address
First Line	:	315 CABLE PL
Second Line	:
City	:	FRONT ROYAL
State	:	VA
Zip	:	22630-3019
Country	:	US
Telephone Number	:	240-643-8756
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 CABLE PL
Second Line	:
City	:	FRONT ROYAL
State	:	VA
Zip	:	22630-3019
Country	:	US
Telephone Number	:	240-643-8756
Fax Number	:

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

Provider Enumeration Date	:	12/22/2023
Last Update Date	:	12/22/2023

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Directions to “ SILVIA PORTILLO ” Practice Location

Language	Start Address	Practice Location

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