Individual
MS. CHARLENE MAYSON PORTNOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW LMFT
Contact information
Practice address
6465 WAYZATA BLVD STE 355, ST LOUIS PARK, MN 55426-1730
(612) 760-2859
(612) 926-8915
Mailing address
6465 WAYZATA BLVD STE 355, ST LOUIS PARK, MN 55426-1730
(612) 760-2859
(612) 926-8915
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
01769
MN
106H00000X
Marriage & Family Therapist
0361
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
158T5P0
BLUE CROSS BLUE SHIELD
MN
01
—
6299260
MEDICA
MN
Enumeration date
03/01/2007
Last updated
09/20/2016
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