Portnoy, Charlene Mayson

Portnoy, Charlene Mayson is an sole proprietor health care provider with primary practice located at 6465 Wayzata Blvd Ste 355 , St Louis Park MN 55426-1730. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Portnoy, Charlene Mayson can be contacted via phone (612) 760-2859.

Contact Information

Primary practice address
6465 Wayzata Blvd Ste 355 St Louis Park MN 55426-1730
Phone: (612) 760-2859
Fax: (612) 926-8915
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 01769 Minnesota
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 0361 Minnesota

Profile Details

NPI number 1578691606
LBN Legal business name Portnoy, Charlene Mayson
Credentials LICSW LMFT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 1st, 2007
Last updated Sep 20th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578691606 NPPES
Minnesota Other 158T5P0 BLUE CROSS BLUE SHIELD
Minnesota Other 6299260 BLUE CROSS BLUE SHIELD

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