Provider Demographics
NPI:1881747954
Name:PORTER, MYRLE ESTHER (MSW)
Entity type:Individual
Prefix:MRS
First Name:MYRLE
Middle Name:ESTHER
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9525
Mailing Address - Country:US
Mailing Address - Phone:413-467-3337
Mailing Address - Fax:
Practice Address - Street 1:121 W STATE ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MA
Practice Address - Zip Code:01033-9614
Practice Address - Country:US
Practice Address - Phone:413-467-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1005071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical