Provider Demographics
NPI:1164665014
Name:PORTMAN, MARCIE WEINER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:WEINER
Last Name:PORTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARCIE
Other - Middle Name:
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1062 LANCASTER AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-525-7527
Mailing Address - Fax:610-525-3997
Practice Address - Street 1:1062 LANCASTER AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-525-7527
Practice Address - Fax:610-525-3997
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004978-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical