Healthcare Provider Details

I. General information

NPI: 1972919413
Provider Name (Legal Business Name): KELLY M PORTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2014
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17A PASCO DR
EAST WINDSOR CT
06088-1700
US

IV. Provider business mailing address

63 FOSTER LN
WINDSOR CT
06095-2014
US

V. Phone/Fax

Practice location:
  • Phone: 860-977-6272
  • Fax:
Mailing address:
  • Phone: 860-977-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2570
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: