Provider Demographics
NPI:1679628887
Name:PORTNOY, ROBERT NORMAN (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NORMAN
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880618
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68588-0618
Mailing Address - Country:US
Mailing Address - Phone:402-472-7450
Mailing Address - Fax:402-472-8010
Practice Address - Street 1:1500 U STREET
Practice Address - Street 2:UNIVERSITY HEALTH CENTER
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68588-0618
Practice Address - Country:US
Practice Address - Phone:402-472-7450
Practice Address - Fax:402-472-8010
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE291103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025123700Medicaid
278235Medicare ID - Type Unspecified