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General NPI Number Information
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NPI Number | 1881945160
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Entity Type | Individual
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Provider Name | ELINE POTOSKI LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 1136 E STUART ST STE 4101
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City | FORT COLLINS
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State | CO
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Zip | 80525-1173
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Country | US
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Telephone | 970-889-0038
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 270996
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City | FORT COLLINS
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State | CO
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Zip | 80527-0996
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Country | US
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Telephone | 970-889-0038
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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 | CSW.09923862
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License Number State | CO
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