Provider Demographics
NPI:1750644613
Name:WESTBROOK PORTER, CINNAMON (PSYD)
Entity Type:Individual
Prefix:
First Name:CINNAMON
Middle Name:
Last Name:WESTBROOK PORTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FREMONT AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6057
Mailing Address - Country:US
Mailing Address - Phone:408-357-3124
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE STE 145
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6057
Practice Address - Country:US
Practice Address - Phone:408-357-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29993103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist