Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 14792 | NY |
N | 103T00000X | Psychologist | 14792 | NY |
N | 102L00000X | Psychologist | PSY19635 | CA |
N | 103T00000X | Psychologist | PSY19635 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 14792 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY19635 | CA |
N | 103G00000X | Clinical Psychologist | 14792 | NY |
N | 103TC0700X | Clinical Psychologist | 14792 | NY |
N | 103G00000X | Clinical Psychologist | PSY19635 | CA |
N | 103TC0700X | Clinical Psychologist | PSY19635 | CA |
N | 103TC1900X | Counseling Psychologist | 14792 | NY |
N | 103TC1900X | Counseling Psychologist | PSY19635 | CA |
N | 103TP2701X | Group Psychotherapist | 14792 | NY |
N | 103TP2701X | Group Psychotherapist | PSY19635 | CA |
NPI | 1558400796 |
---|---|
Provider Name | Dr. Jonathan Porteus |
First Address | Sacramento, CA 95816-6519 |
Second Address | Sacramento, CA 95826-3224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |