Provider Demographics
NPI:1326070525
Name:POTTASH, JOYCE G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:G
Last Name:POTTASH
Suffix:
Gender:F
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:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:OLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19547-0094
Mailing Address - Country:US
Mailing Address - Phone:610-689-9279
Mailing Address - Fax:610-987-2878
Practice Address - Street 1:2866A W PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:OLEY
Practice Address - State:PA
Practice Address - Zip Code:19547-8922
Practice Address - Country:US
Practice Address - Phone:610-689-9279
Practice Address - Fax:610-987-2878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007925L103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01082501OtherCAPITAL BLUE CROSS
PA0863380000OtherKEYSTONE EAST
PA2638605000OtherINDEPENDENCE BLUE CROSS
PA831468OtherHIGHMARK BLUE SHIELD
PA0863380000OtherPERSONAL CHOICE
PA157566OtherVALUEOPTIONS
PA157566OtherVALUEOPTIONS