Provider Demographics
NPI:1316028525
Name:PORIS, JAIME
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:
Last Name:PORIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 E 61ST ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 E 61ST ST
Practice Address - Street 2:APT 4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8509
Practice Address - Country:US
Practice Address - Phone:516-318-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker