Provider Demographics
NPI:1053094169
Name:PORTALATIN, CYNTHIA (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:PORTALATIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9048 SUGAR EST
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3634
Mailing Address - Country:US
Mailing Address - Phone:340-776-8311
Mailing Address - Fax:340-693-6233
Practice Address - Street 1:9048 SUGAR EST
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3634
Practice Address - Country:US
Practice Address - Phone:340-776-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1-29632-1B1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical