Provider Demographics
NPI:1447693643
Name:DE LA PORTILLA, MEGAN ELIZABETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:DE LA PORTILLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:HAUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 BAYWAY BLVD
Mailing Address - Street 2:APT. 4
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2669
Mailing Address - Country:US
Mailing Address - Phone:443-690-0642
Mailing Address - Fax:
Practice Address - Street 1:8823 115TH AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-4922
Practice Address - Country:US
Practice Address - Phone:727-547-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL132811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical