Provider Demographics
NPI:1093981177
Name:PORRECA, LESLIE J (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:PORRECA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 W UWCHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3361
Mailing Address - Country:US
Mailing Address - Phone:802-537-4531
Mailing Address - Fax:802-537-4531
Practice Address - Street 1:56 HOWARD HILL RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:VT
Practice Address - Zip Code:05743-9432
Practice Address - Country:US
Practice Address - Phone:802-537-4531
Practice Address - Fax:802-537-4531
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00730081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical