Provider Demographics
NPI:1235181520
Name:PORCO, ANTONIA FRANCESCA (LCS C AS AC)
Entity Type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:FRANCESCA
Last Name:PORCO
Suffix:
Gender:F
Credentials:LCS C AS AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HAWTHORNE ROAD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754
Mailing Address - Country:US
Mailing Address - Phone:631-431-1449
Mailing Address - Fax:631-979-6067
Practice Address - Street 1:256 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768
Practice Address - Country:US
Practice Address - Phone:631-431-1449
Practice Address - Fax:631-979-6067
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6478101YA0400X
NYRO4031011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02486744Medicaid
NYP3597425OtherOXFORD
A43573Medicare UPIN
NYN20G71Medicare ID - Type Unspecified