Provider Demographics
NPI:1346351608
Name:POLNER, PORTIA (PH D LIC PSYCHOLOGIS)
Entity Type:Individual
Prefix:DR
First Name:PORTIA
Middle Name:
Last Name:POLNER
Suffix:
Gender:F
Credentials:PH D LIC PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 MORELLO AVENUE
Mailing Address - Street 2:STE 119
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:925-798-5323
Mailing Address - Fax:510-339-8183
Practice Address - Street 1:2255 MORELLO AVENUE
Practice Address - Street 2:STE 119
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-798-5323
Practice Address - Fax:510-339-8183
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11003103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110030Medicaid
CA110030Medicaid