Provider Demographics
NPI:1255125142
Name:PORTILLO-CARBAJAL, LUVETH ANDREA (LMSW)
Entity type:Individual
Prefix:
First Name:LUVETH
Middle Name:ANDREA
Last Name:PORTILLO-CARBAJAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13362 TRIADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1144
Mailing Address - Country:US
Mailing Address - Phone:443-535-3352
Mailing Address - Fax:
Practice Address - Street 1:10400 LITTLE PATUXENT PKWY STE 305
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3518
Practice Address - Country:US
Practice Address - Phone:667-800-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD32727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist