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General NPI Number Information
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NPI Number | 1134645252
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Entity Type | Individual
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Provider Name | JAMIE ELIZABETH POTTER LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 326 HIGHLAND AVE
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City | WATERBURY
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State | CT
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Zip | 06708-3021
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Country | US
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Telephone | 203-597-1906
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Fax |
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Provider Business Mailing Address
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Address Line | 123 POVERTY RD
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City | SOUTHBURY
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State | CT
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Zip | 06488-2253
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Country | US
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Telephone | 203-206-6609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3866
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License Number State | CT
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