PORTUM PRIVATE PRACTICE LLC NPI 1255103388

NPI Information

  • NPI: 1255103388
  • Provider Name: PORTUM PRIVATE PRACTICE LLC
  • Classification: Clinic/Center - 261QM0855X
  • Specialization: Adolescent and Children Mental Health
  • Entity Type: Organization
  • Address: 1465 ROUTE 31 S STE 11011102
    ANNANDALE, NJ
    ZIP 08801
  • Phone: (732) 614-0994

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NPI Details

PORTUM PRIVATE PRACTICE LLC is an adolescent and children mental health clinic center in Annandale, NJ. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. PORTUM PRIVATE PRACTICE LLC NPI is 1255103388. The provider is registered as an organization entity type.

The provider's business location address is:

1465 ROUTE 31 S STE 11011102
ANNANDALE, NJ
ZIP 08801-129
Phone: (732) 614-0994

The provider's authorized official is Jeffrey Allen Decker .
The authorized official title is Chief Operating Officer and has the following contact phone number (732) 614-0994.

The enumeration date for this NPI number is 10/23/2023 and was last updated on 10/23/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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