1235757501 NPI number — BRITTNEY S PORTALA MSW, LISW

Table of content: BRITTNEY S PORTALA MSW, LISW (NPI 1235757501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235757501 NPI number — BRITTNEY S PORTALA MSW, LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTALA
Provider First Name:
BRITTNEY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235757501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10715 PARDEE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAYLOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48180-3530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-344-7432
Provider Business Mailing Address Fax Number:
734-344-7431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 W CENTRAL AVE STE 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-210-3660
Provider Business Practice Location Address Fax Number:
734-344-7432
Provider Enumeration Date:
07/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I.2406034 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0410596 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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