Provider Demographics
NPI:1295829828
Name:PORCELLI, JANET LOUISE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:LOUISE
Last Name:PORCELLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01302-1036
Mailing Address - Country:US
Mailing Address - Phone:413-548-6217
Mailing Address - Fax:413-773-9484
Practice Address - Street 1:33 RIDDELL ST
Practice Address - Street 2:SUITE 8
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2025
Practice Address - Country:US
Practice Address - Phone:413-548-6217
Practice Address - Fax:413-773-9484
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110688104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083765AMedicaid
MA70010000PO8265OtherBC/BS
MAP22960Medicare ID - Type Unspecified