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NPI Code Detail

MEDICARE: BRIAN POTTS PSYD, CSAC, BCBA

MEDICARE: BRIAN POTTS PSYD, CSAC, BCBA
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
1103TC0700XClinical PsychologistPY0858NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740610278
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN POTTS PSYD, CSAC, BCBA
Provider Business Mailing Address
First Line : 279 LINCOLN STREET, HAHNEMANN FAMILY HEALTH CENTER
Second Line : UMASS MEMORIAL MEDICAL CENTER
City : WORCESTER
State : MA
Zip : 01605-1736
Country : US
Telephone Number : 508-334-8830
Fax Number : 508-334-8810
Provider Business Practice Location Address
First Line : 4029 DEAN MARTIN DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-4138
Country : US
Telephone Number : 702-848-2256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2013
Last Update Date : 03/22/2019

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