Provider Demographics
NPI:1386441103
Name:PORCHEA, MELVIN JR
Entity type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:PORCHEA
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 MILANO CIR APT 106
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7023
Mailing Address - Country:US
Mailing Address - Phone:813-481-8091
Mailing Address - Fax:
Practice Address - Street 1:806 MILANO CIR APT 106
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7023
Practice Address - Country:US
Practice Address - Phone:813-481-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-411822103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst