Active NPI
Charlene Portnoy LLC
- Clinical Social Worker
- St Louis Park, MN
National Provider Identifier
1780172569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 01769
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 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 DirectoryLocations
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.
-
- Clinical Social Worker
- Minnetonka, MN
- NPI 1790797850
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.