Healthcare Provider Details

I. General information

NPI: 1639660053
Provider Name (Legal Business Name): KATHRYN PORTNOW ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 POWDER MILL RD
MAYNARD MA
01754-1410
US

IV. Provider business mailing address

71 POWDER MILL RD
MAYNARD MA
01754-1410
US

V. Phone/Fax

Practice location:
  • Phone: 781-641-3089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10006901
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: