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General NPI Number Information
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NPI Number | 1972110575
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Entity Type | Individual
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Provider Name | DEREK B POTTS BCBA
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Gender | Male
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 203 S ELMER AVE
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City | SAYRE
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State | PA
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Zip | 18840-2019
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Country | US
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Telephone | 607-760-9520
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 YALE ST
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City | ENDWELL
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State | NY
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Zip | 13760-3281
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Country | US
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Telephone | 607-624-1161
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-36291
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License Number State | CO
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