MEDICARE: DORIS 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1831213594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS PORCELLI

Provider Business Mailing Address
First Line	:	140 NORTH ST
Second Line	:
City	:	CLAREMONT
State	:	NH
Zip	:	03743-2038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 HANOVER ST
Second Line	:	SUITE 2
City	:	LEBANON
State	:	NH
Zip	:	03766-1312
Country	:	US
Telephone Number	:	603-448-0126
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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Directions to “ DORIS PORCELLI ” Practice Location

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