Provider Demographics
NPI:1407011638
Name:POTTER, BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PALMER ST
Mailing Address - Street 2:APT.1
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-5230
Mailing Address - Country:US
Mailing Address - Phone:857-998-9324
Mailing Address - Fax:
Practice Address - Street 1:18 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5812
Practice Address - Country:US
Practice Address - Phone:781-648-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS43957026104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker