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NPI Code Detail

MEDICARE: WENDY PORTER

MEDICARE: WENDY PORTER
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
11041C0700XClinical Social Worker118793MA

General Provider Information

NPI Number : 1588143879
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY PORTER
Provider Business Mailing Address
First Line : 61 INDUSTRIAL PARK RD
Second Line :
City : PLYMOUTH
State : MA
Zip : 02360-7246
Country : US
Telephone Number : 508-732-6331
Fax Number : 508-747-1239
Provider Business Practice Location Address
First Line : 61 INDUSTRIAL PARK RD
Second Line :
City : PLYMOUTH
State : MA
Zip : 02360-7246
Country : US
Telephone Number : 508-732-6331
Fax Number : 508-747-1239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2018
Last Update Date : 08/08/2018

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