Provider Demographics
NPI:1205861457
Name:POTTER, LAURA J (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:J
Last Name:POTTER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1653
Mailing Address - Country:US
Mailing Address - Phone:609-261-2500
Mailing Address - Fax:609-261-2501
Practice Address - Street 1:600 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1653
Practice Address - Country:US
Practice Address - Phone:609-261-2500
Practice Address - Fax:609-261-2501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052584001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical