Provider Demographics
NPI:1760577746
Name:PORTMAN, MICHAEL E (MSW, LISW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:PORTMAN
Suffix:
Gender:M
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:E
Other - Last Name:PORTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LISW
Mailing Address - Street 1:3542 SEVERN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00083411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical