Provider Demographics
NPI:1780761197
Name:PORTER, HARRIET EMERSON (ACSW, LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:HARRIET
Middle Name:EMERSON
Last Name:PORTER
Suffix:
Gender:F
Credentials:ACSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 CHAPEL CT
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4642
Mailing Address - Country:US
Mailing Address - Phone:847-559-8718
Mailing Address - Fax:847-272-9127
Practice Address - Street 1:1662 CHAPEL CT
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4642
Practice Address - Country:US
Practice Address - Phone:847-559-8718
Practice Address - Fax:847-272-9127
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490040251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL374180Medicare ID - Type Unspecified