MEDICARE: MARISEL PORRATA

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
1	106S00000X	Behavior Technician	RBT-24-367417	VA

General Provider Information

NPI Number	:	1932939493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISEL PORRATA

Provider Business Mailing Address
First Line	:	6465 COLLEGE PARK SQ STE 210
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3622
Country	:	US
Telephone Number	:	757-336-8356
Fax Number	:	757-257-3450

Provider Business Practice Location Address
First Line	:	6465 COLLEGE PARK SQ STE 210
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3622
Country	:	US
Telephone Number	:	757-336-8356
Fax Number	:	757-257-3450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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Directions to “ MARISEL PORRATA ” Practice Location

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