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General NPI Number Information
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NPI Number | 1043190051
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Entity Type | Individual
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Provider Name | SERA LESLIE PORTER MHC
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Gender | Female
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 333 17TH ST STE M
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City | VERO BEACH
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State | FL
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Zip | 32960-5686
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Country | US
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Telephone | 775-758-1906
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Fax |
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Provider Business Mailing Address
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Address Line | 225 31ST AVE SW
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City | VERO BEACH
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State | FL
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Zip | 32968-3211
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Country | US
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Telephone | 518-810-5527
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH25195
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License Number State | FL
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