# PORTUM PRIVATE PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528802568
- **Authorized official:** JEFFREY DECKER MHA (COO)
- **Authorized official phone:** (732) 614-0994

## Contact information

- **Practice address:** 1465 ROUTE 31 S, ANNANDALE, NJ 08801-3129
- **Practice address phone:** (732) 614-0994
- **Mailing address:** 1465 ROUTE 31 S, ANNANDALE, NJ 08801-3129

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 06/24/2024
- **Last updated:** 06/24/2024