Provider Demographics
NPI:1851622013
Name:PORTER, ROCLYN RENEE (LMFT, MS)
Entity Type:Individual
Prefix:MRS
First Name:ROCLYN
Middle Name:RENEE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMFT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 W SHORE PARK RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-3548
Mailing Address - Country:US
Mailing Address - Phone:603-686-1624
Mailing Address - Fax:
Practice Address - Street 1:85 N STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4334
Practice Address - Country:US
Practice Address - Phone:603-228-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30850605Medicaid