Provider Demographics
NPI:1417342650
Name:PORTER, LAUREL
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 PINE GLEN CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4046
Mailing Address - Country:US
Mailing Address - Phone:941-587-4919
Mailing Address - Fax:941-460-6275
Practice Address - Street 1:338 PINE GLEN CT
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4046
Practice Address - Country:US
Practice Address - Phone:941-587-4919
Practice Address - Fax:941-460-6275
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst