Provider Demographics
NPI:1457663387
Name:PORCO, JENNIFER SLANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SLANE
Last Name:PORCO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DANIELLE
Other - Last Name:SLANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1697 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8514
Mailing Address - Country:US
Mailing Address - Phone:412-378-2248
Mailing Address - Fax:
Practice Address - Street 1:1009 BEAVER GRADE RD STE 230
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2969
Practice Address - Country:US
Practice Address - Phone:412-314-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019026103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical