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General NPI Number Information
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NPI Number | 1669271870
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Entity Type | Organization
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Legal Business Name | POTENTILLA THERAPY PLLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 196 WOODLAND ST UNIT 1C
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City | BRISTOL
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State | CT
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Zip | 06010-5283
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Country | US
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Telephone | 860-309-5569
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Fax |
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Provider Business Mailing Address
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Address Line | 83 BIRGE ST APT 7
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City | TORRINGTON
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State | CT
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Zip | 06790-5575
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Country | US
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Telephone | 860-309-5569
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Fax |
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Authorized Official
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Title or Position | OWNER/LCSW
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Name | AMANDA DILL
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Credential | LCSW
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Telephone | 860-309-5569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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