Provider Demographics
NPI:1134645252
Name:POTTER, JAMIE ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 POVERTY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2253
Mailing Address - Country:US
Mailing Address - Phone:203-206-6609
Mailing Address - Fax:
Practice Address - Street 1:326 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3021
Practice Address - Country:US
Practice Address - Phone:203-597-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3866104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker