Healthcare Provider Details

I. General information

NPI: 1861819062
Provider Name (Legal Business Name): DANIEL ROBERTSON POTTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HATCH RUN RD STE 4
NORTH WARREN PA
16365-5249
US

IV. Provider business mailing address

60 HATCH RUN RD STE 4
NORTH WARREN PA
16365-5249
US

V. Phone/Fax

Practice location:
  • Phone: 148-176-8088
  • Fax:
Mailing address:
  • Phone: 148-176-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC017055
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: