Healthcare Provider Details

I. General information

NPI: 1891659991
Provider Name (Legal Business Name): PENELOPE POTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 COMMERCE ST
HINESBURG VT
05461-4460
US

IV. Provider business mailing address

77 OVERLAKE PARK
BURLINGTON VT
05401-4014
US

V. Phone/Fax

Practice location:
  • Phone: 914-262-8575
  • Fax:
Mailing address:
  • Phone: 914-262-8575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: