Perrine Portillo, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY31525 Issued in CA

Practice address

10368 Donner Pass Rd
Truckee, CA 96161-0427

Phone

(530) 536-0663

NPI assigned

Sep 9, 2015

Last updated

Feb 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 23, 2021 through Feb 23, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Authentic Connections Psychotherapy, Inc.

  • Clinical Psychologist
  • Truckee, CA
  • NPI 1255084745
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1023486958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11260 DONNER PASS RD. STE C1",
            "address_2": "PMB 635",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "96161",
            "telephone_number": "530-536-0663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10368 DONNER PASS RD",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961610427",
            "telephone_number": "530-536-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTILLO",
        "first_name": "PERRINE",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-09",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY31525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Edward Pierce
• Courtney Platt
• Jeanne Murphy Plumb, M.D.
• Melissa Polanco, MSW, LSWAIC
• Mary Anne Polucha, DC
• Patricia B Post, PT
• Shayna Raeanne Pourkhomami, LCSW
• Michelle Soraya Pourtabib, MD
• Lisa Marie Powell, MA, LMFT
• Katelyn Price

• Clinical Psychologist in Truckee, CA
• Providers in Truckee, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.