Provider Demographics
NPI:1083698120
Name:PORTER, DAWN SHERYL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:SHERYL
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:SHERYL
Other - Last Name:PRITCHETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:13193 CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7200
Mailing Address - Country:US
Mailing Address - Phone:909-902-9111
Mailing Address - Fax:909-902-9199
Practice Address - Street 1:540 WEST BASELINE ROAD
Practice Address - Street 2:STE 3
Practice Address - City:CLAIRMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:909-902-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS203981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical