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NPI Code Detail

MEDICARE: MRS. LAURA J POTTER MSW, LCSW

MEDICARE: MRS. LAURA J POTTER MSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SC05258400NJ

General Provider Information

NPI Number : 1205861457
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA J POTTER MSW, LCSW
Provider Business Mailing Address
First Line : 600 NEW RD
Second Line :
City : NORTHFIELD
State : NJ
Zip : 08225-1653
Country : US
Telephone Number : 609-261-2500
Fax Number : 609-261-2501
Provider Business Practice Location Address
First Line : 600 NEW RD
Second Line :
City : NORTHFIELD
State : NJ
Zip : 08225-1653
Country : US
Telephone Number : 609-261-2500
Fax Number : 609-261-2501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 07/08/2007

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