Provider Demographics
NPI:1497190466
Name:POTERE, LINDA (CAP, LADAC, LHCRM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:POTERE
Suffix:
Gender:F
Credentials:CAP, LADAC, LHCRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 EQUUS CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4312
Mailing Address - Country:US
Mailing Address - Phone:561-738-1369
Mailing Address - Fax:561-738-4968
Practice Address - Street 1:885 SE 6TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5184
Practice Address - Country:US
Practice Address - Phone:561-777-4939
Practice Address - Fax:561-330-4255
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL193101YA0400X
FL50291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50291OtherFLORIDA CERTIFICATION BOARD, CMHP
FL193OtherFLORIDA CERTIFICATION BOARD, CAP