Provider Demographics
NPI:1548808579
Name:PORTER, ROBERT ALLEN (CADC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:PORTER
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2200
Mailing Address - Country:US
Mailing Address - Phone:207-213-7101
Mailing Address - Fax:
Practice Address - Street 1:321 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974-3640
Practice Address - Country:US
Practice Address - Phone:207-338-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6994101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)