Provider Demographics
NPI:1013123256
Name:PORTER, JODY (LCSW R)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:PORTER WOLOSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8 DIANE COURT
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-737-1732
Mailing Address - Fax:914-737-1732
Practice Address - Street 1:8 DIANE COURT
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-737-1732
Practice Address - Fax:914-737-1732
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0304821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN72182Medicare ID - Type Unspecified