Provider Demographics
NPI:1407612138
Name:TROMBLEY, PORSCHE
Entity Type:Individual
Prefix:
First Name:PORSCHE
Middle Name:
Last Name:TROMBLEY
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 1:2503 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4753
Mailing Address - Country:US
Mailing Address - Phone:802-309-4370
Mailing Address - Fax:
Practice Address - Street 1:2503 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-4753
Practice Address - Country:US
Practice Address - Phone:802-309-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-51244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst