Healthcare Provider Details

I. General information

NPI: 1164665014
Provider Name (Legal Business Name): MARCIE WEINER PORTMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCIE WEINER PSY.D.

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 LANCASTER AVE. SUITE 2
ROSEMONT PA
19010
US

IV. Provider business mailing address

1062 LANCASTER AVE. SUITE 2
ROSEMONT PA
19010
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-7527
  • Fax: 610-525-3997
Mailing address:
  • Phone: 610-525-7527
  • Fax: 610-525-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS004978-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: