Provider Demographics
NPI:1164571964
Name:POTENZA, LUISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LUISA
Middle Name:
Last Name:POTENZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LUISA
Other - Middle Name:POTENZA
Other - Last Name:LEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:755 NARROWS RD N APT 814
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1540
Mailing Address - Country:US
Mailing Address - Phone:718-496-9468
Mailing Address - Fax:718-226-6578
Practice Address - Street 1:88 NEW DORP PLZ S STE 200
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2902
Practice Address - Country:US
Practice Address - Phone:718-496-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040561-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02176929Medicaid
NYNV6831Medicare ID - Type Unspecified