Provider Demographics
NPI:1790007839
Name:PORTER, PATRICIA MAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MAE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13407 POSSUM ROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4763
Mailing Address - Country:US
Mailing Address - Phone:210-880-4440
Mailing Address - Fax:260-572-3757
Practice Address - Street 1:13407 POSSUM ROCK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4763
Practice Address - Country:US
Practice Address - Phone:210-880-4440
Practice Address - Fax:260-572-3757
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX420261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical