| Doctor Name: | DR. CAROL L. PORTER |
| NPI Number: | 1215043393 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | EDD |
| License Number: | SI 1459 |
| Business Practice Address: | 51 Upper Montclair Plz Suite #27 Upper Montclair, NJ - 070431343 |
| Business Phone Number: | 9737834511 |
| Business Fax Number: | 9737832844 |
| Mailing Address: | 51 Upper Montclair Plz, Suite #27 UPPER MONTCLAIR |
| State: | NJ |
| Postal Code: | 070431343 |
| Phone Number: | 9737834511 |
| Fax Number: | 9737832844 |
| NPI Enumeration Date: | 08/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | SI 1459 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |