| Charlene Portnoy Llc | |
|
6465 Wayzata Blvd Ste 355 St Louis Park MN 55426-1730 | |
| (612) 760-2859 | |
| (612) 926-8915 |
| Full Name | Charlene Portnoy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 6465 Wayzata Blvd Ste 355, St Louis Park, Minnesota |
| Authorized Official Name and Position | Charlene Mayson Portnoy (LICSW, LMFT) |
| Authorized Official Contact | 6127602859 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charlene Portnoy Llc 6465 Wayzata Blvd Ste 355 St Louis Park MN 55426-1730 Ph: (612) 760-2859 | Charlene Portnoy Llc 6465 Wayzata Blvd Ste 355 St Louis Park MN 55426-1730 Ph: (612) 760-2859 |
| NPI Number | 1780172569 |
|---|---|
| Provider Enumeration Date | 04/26/2018 |
| Last Update Date | 04/26/2018 |
| Medicare PECOS PAC ID | 2466716485 |
|---|---|
| Medicare Enrollment ID | O20180427001320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780172569 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 01769 (Minnesota) | Primary |
| Provider Name | Charlene M Portnoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578691606 PECOS PAC ID: 2163786187 Enrollment ID: I20180427001487 |
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