1669662250 NPI number — MRS. MELANIE ROBIN PORTER LICSW

Table of content: MRS. MELANIE ROBIN PORTER LICSW (NPI 1669662250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669662250 NPI number — MRS. MELANIE ROBIN PORTER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTER
Provider First Name:
MELANIE
Provider Middle Name:
ROBIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TROVAGE
Provider Other First Name:
MELANIE
Provider Other Middle Name:
ROBIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669662250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 CUMMINGS CTR
Provider Second Line Business Mailing Address:
SUITE 416-T
Provider Business Mailing Address City Name:
BEVERLY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01915-6198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-365-0408
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 CUMMINGS CTR
Provider Second Line Business Practice Location Address:
SUITE 416-T
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915-6198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-365-0408
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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