Provider Demographics
NPI:1467052803
Name:PORTER, SERI ELAINE (MSW, LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:SERI
Middle Name:ELAINE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSW, LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 N GREENVIEW AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1173
Mailing Address - Country:US
Mailing Address - Phone:773-870-1591
Mailing Address - Fax:
Practice Address - Street 1:4258 N GREENVIEW AVE APT 2D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1173
Practice Address - Country:US
Practice Address - Phone:773-870-1591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490044541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical