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General NPI Number Information
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NPI Number | 1851622013
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Entity Type | Individual
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Provider Name | ROCLYN RENEE PORTER LMFT, MS
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Gender | Female
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 85 N STATE ST
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City | CONCORD
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State | NH
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Zip | 03301-4334
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Country | US
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Telephone | 603-228-3266
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Fax |
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Provider Business Mailing Address
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Address Line | 29 W SHORE PARK RD
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City | KINGSTON
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State | NH
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Zip | 03848-3548
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Country | US
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Telephone | 603-686-1624
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 125
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License Number State | NH
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