Provider Demographics
NPI:1154383818
Name:PORTER-MULLER, JUDITH (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:PORTER-MULLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:PORTER-MULLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:197 HACKER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-7163
Mailing Address - Country:US
Mailing Address - Phone:207-725-2379
Mailing Address - Fax:207-721-9700
Practice Address - Street 1:16B LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1912
Practice Address - Country:US
Practice Address - Phone:207-721-9700
Practice Address - Fax:207-721-9700
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC40261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical