Provider Demographics
NPI:1902134679
Name:HASPEL-PORTNER, ELEANOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:HASPEL-PORTNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1783 SHELL RING CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8030
Mailing Address - Country:US
Mailing Address - Phone:310-403-4347
Mailing Address - Fax:310-454-5318
Practice Address - Street 1:1783 SHELL RING CIR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8030
Practice Address - Country:US
Practice Address - Phone:310-403-4347
Practice Address - Fax:310-454-5318
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY5297OtherBOARD OF PSYCHOLOGY