Provider Demographics
NPI:1114516846
Name:PORTNOY, DEBORAH (MASTER)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:PORTNOY
Suffix:
Gender:F
Credentials:MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1327
Mailing Address - Country:US
Mailing Address - Phone:786-426-1817
Mailing Address - Fax:
Practice Address - Street 1:1414 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2732
Practice Address - Country:US
Practice Address - Phone:786-762-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH17812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health