Organization Active NPI

Charlene Portnoy LLC

  • Clinical Social Worker
  • St Louis Park, MN
National Provider Identifier
1780172569
Registry record updated Apr 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
01769 Issued in MN
Legal business name
CHARLENE PORTNOY LLC
Practice address
6465 Wayzata Blvd Ste 355
St Louis Park, MN 55426-1730
Phone
(612) 760-2859
Fax
(612) 926-8915
NPI assigned
Apr 26, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2018

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

Authorized official

Name
Charlene Mayson Portnoy, MSW
Title
Licsw, LMFT
Phone
(612) 760-2859

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 01769 MN Primary

Addresses

Primary practice location

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

Mailing address

6465 Wayzata Blvd Ste 355
St Louis Park, MN 55426-1730
Phone (612) 760-2859

National Provider Directory

National Provider Directory

Locations

6465 Wayzata Blvd
Ste 355
St Louis Park, MN 55426
Phone (612) 760-2859

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1780172569",
    "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": {
        "organization_name": "CHARLENE PORTNOY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-26",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "PORTNOY",
        "authorized_official_first_name": "CHARLENE",
        "authorized_official_middle_name": "MAYSON",
        "authorized_official_title_or_position": "LICSW, LMFT",
        "authorized_official_telephone_number": "612-760-2859",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "01769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.