Provider Demographics
NPI:1871969170
Name:PORTER, SHELLEY DENISE (BSW)
Entity type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:DENISE
Last Name:PORTER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PARK AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-5232
Mailing Address - Country:US
Mailing Address - Phone:973-651-7438
Mailing Address - Fax:
Practice Address - Street 1:105 PARK AVE APT 1B
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-5232
Practice Address - Country:US
Practice Address - Phone:973-651-7438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor