Provider Demographics
NPI:1912181272
Name:PORTER, DEBORAH JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:JOAN
Last Name:PORTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHICHESTER RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6340
Mailing Address - Country:US
Mailing Address - Phone:631-351-1649
Mailing Address - Fax:631-351-1649
Practice Address - Street 1:115 CHICHESTER RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6340
Practice Address - Country:US
Practice Address - Phone:631-351-1649
Practice Address - Fax:631-351-1649
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6072103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical