Healthcare Provider Details

I. General information

NPI: 1942722723
Provider Name (Legal Business Name): VALERIE DENISON PORCELLO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 CAMPUS AVE
LEWISTON ME
04240-6030
US

IV. Provider business mailing address

116 MADELINE ST
PORTLAND ME
04103-1720
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-8700
  • Fax: 207-777-8826
Mailing address:
  • Phone: 843-412-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP181146
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2330167
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: