MEDICARE: MR. RYAN POTTER LCSW, MCAP

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
1	1041C0700X	Clinical Social Worker	SW12351	FL

General Provider Information

NPI Number	:	1750746558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN POTTER LCSW, MCAP

Provider Business Mailing Address
First Line	:	310A E OCEAN AVE
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-3257
Country	:	US
Telephone Number	:	561-531-9898
Fax Number	:

Provider Business Practice Location Address
First Line	:	8800 SUNSET DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6233
Country	:	US
Telephone Number	:	561-531-9898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	12/21/2015

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