| NPI | 1780172569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE MAYSON PORTNOY Licsw, Lmft 612-760-2859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 01769) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2018-04-26 |