Provider Demographics
NPI:1093903528
Name:PORIER, GRETCHEN E (LTM)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:E
Last Name:PORIER
Suffix:
Gender:F
Credentials:LTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MORGAN AVE
Mailing Address - Street 2:A
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3214
Mailing Address - Country:US
Mailing Address - Phone:607-742-7945
Mailing Address - Fax:
Practice Address - Street 1:12 MORGAN AVE
Practice Address - Street 2:A
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3214
Practice Address - Country:US
Practice Address - Phone:607-742-7945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017124-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist