Healthcare Provider Details

I. General information

NPI: 1568400661
Provider Name (Legal Business Name): SIDNEY PORTNOY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S BROAD ST SUITE 220
LANSDALE PA
19446-2021
US

IV. Provider business mailing address

1240 S BROAD ST SUITE 220
LANSDALE PA
19446-2021
US

V. Phone/Fax

Practice location:
  • Phone: 215-699-3901
  • Fax: 215-699-3909
Mailing address:
  • Phone: 215-699-3901
  • Fax: 215-699-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SIDNEY PORTNOY
Title or Position: OWNER DIRECTOR
Credential: PHD
Phone: 215-699-3901