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General NPI Number Information
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NPI Number | 1710128632
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Entity Type | Individual
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Provider Name | JOHN L. POTASH LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 6106 EDMONDSON AVE
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City | BALTIMORE
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State | MD
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Zip | 21228-1830
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Country | US
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Telephone | 410-960-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 OAK LODGE RD
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City | CATONSVILLE
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State | MD
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Zip | 21228-4765
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Country | US
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Telephone | 410-960-7744
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12923
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006154
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 073180
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License Number State | NY
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