Provider Demographics
NPI:1225341696
Name:POTASHNER, IRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:POTASHNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 S MAIN ST STE 209
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2403
Mailing Address - Country:US
Mailing Address - Phone:646-575-5848
Mailing Address - Fax:
Practice Address - Street 1:61 S MAIN ST STE 209
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2403
Practice Address - Country:US
Practice Address - Phone:646-575-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019399103TC0700X
CT3424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical