Healthcare Provider Details

I. General information

NPI: 1245146448
Provider Name (Legal Business Name): LEAH POTTER-WEIGHT LMSW (PROVISIONAL)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 INDUSTRIAL PARK RD
ESPANOLA NM
87532-3600
US

IV. Provider business mailing address

PO BOX 147
CHIMAYO NM
87522-0147
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7395
  • Fax:
Mailing address:
  • Phone: 517-974-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0614
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: