Provider Demographics
NPI:1750644613
Name:WESTBROOK PORTER, CINNAMON (PSYD)
Entity type:Individual
Prefix:
First Name:CINNAMON
Middle Name:
Last Name:WESTBROOK PORTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 GASTON AVE STE 1132
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3956
Mailing Address - Country:US
Mailing Address - Phone:408-357-3124
Mailing Address - Fax:469-557-1755
Practice Address - Street 1:6301 GASTON AVE STE 1132
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3956
Practice Address - Country:US
Practice Address - Phone:408-357-3124
Practice Address - Fax:469-557-1755
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29993103T00000X
TX40200103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist