Healthcare Provider Details

I. General information

NPI: 1538005459
Provider Name (Legal Business Name): DEVON ELIZABETH POTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 263
WALLKILL NY
12589-0263
US

IV. Provider business mailing address

PO BOX 263
WALLKILL NY
12589-0263
US

V. Phone/Fax

Practice location:
  • Phone: 845-597-0321
  • Fax:
Mailing address:
  • Phone: 845-597-0321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP128055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: