Kimberly Portugal, LCSW, MPH

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW18454 Issued in AZ

Practice address

1155 S Power Rd Ste 249
Mesa, AZ 85206-3715

Phone

(747) 333-2460

NPI assigned

Oct 10, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1659913655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10313 E THORNTON AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852128355",
            "telephone_number": "949-291-1868",
            "fax_number": "310-818-5592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 S POWER RD STE 249",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063715",
            "telephone_number": "747-333-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTUGAL",
        "first_name": "KIMBERLY",
        "credential": "LCSW, MPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "19692",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW18454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.