Active NPI
Sanford Marvin Portnoy, PH.D.
- Psychologist
- Waban, MA
National Provider Identifier
1467545798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 278
- Practice address
- 35 Helene Rd
Waban, MA 02468-1024 - Phone
- (617) 965-2147
- Fax
- (617) 527-3538
- NPI assigned
- Sep 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 278 | MA | Primary |
Addresses
Primary practice location
35 Helene Rd
Waban, MA 02468-1024
Mailing address
35 Helene Rd
Waban, MA 02468-1024
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 278 | MA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467545798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 HELENE RD",
"city": "WABAN",
"state": "MA",
"postal_code": "024681024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 HELENE RD",
"city": "WABAN",
"state": "MA",
"postal_code": "024681024",
"telephone_number": "617-965-2147",
"fax_number": "617-527-3538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTNOY",
"first_name": "SANFORD",
"middle_name": "MARVIN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waban, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.