Active NPI
Omar Portillo
- School Social Worker
- Brentwood, NY
National Provider Identifier
1750132213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- License
- 113784
- Practice address
- 2 6TH Ave
Brentwood, NY 11717-6110 - Phone
- (631) 434-2204
- NPI assigned
- Apr 1, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 113784 | NY | |
| School Social Worker | 1041S0200X | 113784 | NY | Primary |
Addresses
Primary practice location
2 6TH Ave
Brentwood, NY 11717-6110
Mailing address
116 Waverly Ave Apt 4
Patchogue, NY 11772-2186
Phone (631) 520-3997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113784 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711929600000",
"number": "1750132213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 WAVERLY AVE APT 4",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117722186",
"telephone_number": "631-520-3997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 6TH AVE",
"city": "BRENTWOOD",
"state": "NY",
"postal_code": "117176110",
"telephone_number": "631-434-2204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTILLO",
"first_name": "OMAR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-01",
"last_updated": "2024-04-01",
"certification_date": "2024-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "113784",
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "NY",
"license": "113784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brentwood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.