Provider Demographics
NPI:1942722723
Name:PORCELLO, VALERIE DENISON (PMHNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:DENISON
Last Name:PORCELLO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MADELINE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1720
Mailing Address - Country:US
Mailing Address - Phone:843-412-7828
Mailing Address - Fax:
Practice Address - Street 1:93 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6030
Practice Address - Country:US
Practice Address - Phone:207-777-8700
Practice Address - Fax:207-777-8826
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181146363LP0808X
MA2330167363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health