Charlene Mayson Portnoy, LICSW LMFT

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

01769 Issued in MN

Practice address

6465 Wayzata Blvd Ste 355
St Louis Park, MN 55426-1730

Phone

(612) 760-2859

Fax

(612) 926-8915

NPI assigned

Mar 1, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474329600000",
    "number": "1578691606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD STE 355",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261730",
            "telephone_number": "612-760-2859",
            "fax_number": "612-926-8915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD STE 355",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261730",
            "telephone_number": "612-760-2859",
            "fax_number": "612-926-8915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTNOY",
        "first_name": "CHARLENE",
        "middle_name": "MAYSON",
        "name_prefix": "Ms.",
        "credential": "LICSW LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2016-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "01769",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "0361",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "158T5P0",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6299260",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelbi Polland
• Melissa Rosewall Polski, MSW, LICSW
• Elena L Polukhin, MD, PHD
• Elin Christine Pool, PA-C
• Rachel Marie Porteous, R.D., L.D.
• Posnick Dental Care PA
• Steven Mark Posnick, DDS
• Krista Gay Post, MA LP
• Weston Poucher, RN, DNP, CRNA
• Erin Powell

• Clinical Social Worker in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.