Provider Demographics
NPI:1871618157
Name:POTTER COUNSELING AND EVALUATION SERVICE, CSW, PC
Entity type:Organization
Organization Name:POTTER COUNSELING AND EVALUATION SERVICE, CSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:845-355-1092
Mailing Address - Street 1:523 RIDGEBURY RD
Mailing Address - Street 2:
Mailing Address - City:SLATE HILL
Mailing Address - State:NY
Mailing Address - Zip Code:10973-4310
Mailing Address - Country:US
Mailing Address - Phone:845-355-1092
Mailing Address - Fax:845-355-6535
Practice Address - Street 1:523 RIDGEBURY RD
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973-4310
Practice Address - Country:US
Practice Address - Phone:845-355-1092
Practice Address - Fax:845-355-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7478469OtherGHI VALUE OPTIONS