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General NPI Number Information
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NPI Number | 1225341696
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Entity Type | Individual
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Provider Name | IRA POTASHNER PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 61 S MAIN ST STE 209
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2403
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Country | US
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Telephone | 646-575-5848
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Fax |
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Provider Business Mailing Address
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Address Line | 61 S MAIN ST STE 209
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2403
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Country | US
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Telephone | 646-575-5848
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 019399
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3424
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License Number State | CT
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