Clyte Lydia Portis, LCSW, LISW-CP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW003792 Issued in GA

Practice address

254 41St St
BLDG 40709
Fort Gordon, GA 30905-5918

Phone

(707) 787-1595

Fax

(706) 787-1099

NPI assigned

Apr 2, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• A Brighter Day Counseling and Family Services

  • Clinical Social Worker
  • Augusta, GA
  • NPI 1205028081
  NPD (past) Authorized official

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383004800000",
    "number": "1447423157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 41ST ST",
            "address_2": "BLDG 40709",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055918",
            "telephone_number": "707-787-1595",
            "fax_number": "706-787-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 41ST ST",
            "address_2": "BLDG 40709",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055918",
            "telephone_number": "707-787-1595",
            "fax_number": "706-787-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTIS",
        "first_name": "CLYTE",
        "middle_name": "LYDIA",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LISW-CP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-02",
        "last_updated": "2013-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "CSW003792",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003792",
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "GA",
            "license": "CSW003792",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA SOCIAL WORK LICENSURE",
            "identifier": "CSW003792",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheldon John Phillips
• Jacqueline D Plummer, BSN, RN
• Tamara Polidore-Leconte, OTR
• Elizabeth Lee Pollock, LCSW-C
• Kelly Denise Poole
• David Merica Powell, OTR
• Tyler Alexander Powell, M.D.
• Beth R Powers, RDH
• Hosamane S Prabhakara, MD
• Christopher Shane Pritchard

• Clinical Social Worker in Fort Gordon, GA
• Providers in Fort Gordon, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.