Provider Demographics
NPI:1285712273
Name:BLASER PORTE, MEGGY MARY ELLYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MEGGY
Middle Name:MARY ELLYN
Last Name:BLASER PORTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 S STATE ROAD 7
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068
Mailing Address - Country:US
Mailing Address - Phone:954-979-3655
Mailing Address - Fax:954-979-7939
Practice Address - Street 1:767 S STATE ROAD 7
Practice Address - Street 2:SUITE 16
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068
Practice Address - Country:US
Practice Address - Phone:954-979-3655
Practice Address - Fax:954-979-7939
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW44031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7488OtherBLUE CROSS BLUE SHIELD
FL7808106OtherAETNA
FLZ7488OtherBLUE CROSS BLUE SHIELD
FLZ7488Medicare ID - Type Unspecified