Provider Demographics
NPI:1598077463
Name:PORTER, MEREDITH (PSYD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5229
Mailing Address - Country:US
Mailing Address - Phone:925-295-4619
Mailing Address - Fax:
Practice Address - Street 1:710 S BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5229
Practice Address - Country:US
Practice Address - Phone:252-954-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health