Provider Demographics
NPI:1912062563
Name:PORTEN, BETH MARLENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:MARLENE
Last Name:PORTEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4503
Mailing Address - Country:US
Mailing Address - Phone:215-481-0264
Mailing Address - Fax:215-481-0263
Practice Address - Street 1:1703 LANGHORNE NEWTOWN RD
Practice Address - Street 2:SUITE #2
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1082
Practice Address - Country:US
Practice Address - Phone:215-860-4420
Practice Address - Fax:215-481-0263
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007401L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7365112OtherAETNA HEALTH PLAN
PA0733941000OtherMAGELLAN BEHAVIORAL HEALT
PA085757Medicare ID - Type Unspecified