MEDICARE: STEPHANIE PORRECA

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
1	1041C0700X	Clinical Social Worker	44SC05447600	NJ

General Provider Information

NPI Number	:	1801768692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PORRECA

Provider Business Mailing Address
First Line	:	307 TRESCOTT PL
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-6243
Country	:	US
Telephone Number	:	856-430-2165
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 TRESCOTT PL
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-6243
Country	:	US
Telephone Number	:	856-430-2164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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Directions to “ STEPHANIE PORRECA ” Practice Location

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