Provider Demographics
NPI:1669756524
Name:PORCELLI, RICHARD C JR (MA,LMHC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:PORCELLI
Suffix:JR
Gender:M
Credentials:MA,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 PARK AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-2647
Practice Address - Country:US
Practice Address - Phone:401-383-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health