Provider Demographics
NPI:1063561579
Name:PORCELLO, VIRGINIA E (PHD LMHC)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:E
Last Name:PORCELLO
Suffix:
Gender:F
Credentials:PHD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-877-0200
Mailing Address - Fax:516-877-0211
Practice Address - Street 1:1517 FRANKLIN AVE
Practice Address - Street 2:SUITE # 100
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4804
Practice Address - Country:US
Practice Address - Phone:516-877-0200
Practice Address - Fax:516-877-0211
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001344-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health