Lizandra M Portalatin, MA, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37AC00529000 Issued in NJ

Practice address

100 Walnut Ave Ste 210
Clark, NJ 07066-1269

Phone

(732) 454-7810

NPI assigned

May 15, 2020

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

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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 and National Provider Directory roles.

• Grace Space Counseling LLC

  • Mental Health Counselor
  • Clark, NJ
  • NPI 1851119929
  Medicare reassignment NPD Authorized official
• Wellsprings Counseling Center, LLC

  • Clinical Social Worker
  • Fair Lawn, NJ
  • NPI 1285844050
  NPD

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

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1346862000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WALNUT AVE STE 210",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661269",
            "telephone_number": "732-454-7810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WALNUT AVE STE 210",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661269",
            "telephone_number": "732-454-7810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTALATIN",
        "first_name": "LIZANDRA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-15",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37AC00529000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pharma-Care, Inc.
• Sandra Marie Pietrewicz, P.T.
• Eurica Pinthieve
• Michelle Poff, LAC
• Patricia Dianne Pomponio, R.D.
• Porto Physical Therapy & Wellness, P.a.
• Erin Melissa Power, DMD
• Sudhanshu Prasad, M.D
• Primary Care Group LLC
• Tara Prisco, PA

• Mental Health Counselor in Clark, NJ
• Providers in Clark, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.