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NPI Code Detail

MEDICARE: REBECCA L PORTER LCPC-C

MEDICARE:   REBECCA L PORTER  LCPC-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorXL4360ME

General Provider Information

NPI Number : 1255749628
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA L PORTER LCPC-C
Provider Business Mailing Address
First Line : 14 RIVERVIEW RD
Second Line :
City : BATH
State : ME
Zip : 04530-1632
Country : US
Telephone Number : 207-522-5663
Fax Number :
Provider Business Practice Location Address
First Line : 98 MAINE ST
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-2031
Country : US
Telephone Number : 207-522-5663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2014
Last Update Date : 07/07/2016

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Directions to “ REBECCA L PORTER LCPC-C” Practice Location

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