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General NPI Number Information
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NPI Number | 1093981177
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Entity Type | Individual
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Provider Name | LESLIE J PORRECA LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 56 HOWARD HILL RD
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City | BENSON
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State | VT
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Zip | 05743-9432
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Country | US
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Telephone | 802-537-4531
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Fax | 802-537-4531
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Provider Business Mailing Address
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Address Line | 273 W UWCHLAN AVE
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-3361
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Country | US
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Telephone | 802-537-4531
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Fax | 802-537-4531
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0073008
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License Number State | VT
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