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NPI Code Detail

MEDICARE: TARA PORCELLI

MEDICARE: TARA PORCELLI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor180186OH
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1285198770
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA PORCELLI
Provider Business Mailing Address
First Line : 136 E BEECHWOOD AVE
Second Line :
City : DAYTON
State : OH
Zip : 45405-3130
Country : US
Telephone Number : 937-520-8149
Fax Number :
Provider Business Practice Location Address
First Line : 2400 W STROOP RD
Second Line :
City : DAYTON
State : OH
Zip : 45439-2041
Country : US
Telephone Number : 937-701-7599
Fax Number : 937-424-9692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2019
Last Update Date : 05/16/2022

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Directions to “ TARA PORCELLI ” Practice Location

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