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NPI Code Detail

MEDICARE: RACHEL B POTTER LICSW

MEDICARE:   RACHEL B POTTER  LICSW
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 Worker121362MA
21041C0700XClinical Social Worker32043MN

General Provider Information

NPI Number : 1306274311
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL B POTTER LICSW
Provider Business Mailing Address
First Line : PO BOX 27258
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87125-7258
Country : US
Telephone Number : 505-504-7161
Fax Number : 505-345-4513
Provider Business Practice Location Address
First Line : 1032 GRAND AVE STE 100
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-3064
Country : US
Telephone Number : 214-457-5884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2013
Last Update Date : 05/24/2023

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Directions to “ RACHEL B POTTER LICSW” Practice Location

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