Provider Demographics
NPI:1578104089
Name:IRA POTASHNER PSYD PLLC
Entity Type:Organization
Organization Name:IRA POTASHNER PSYD PLLC
Other - Org Name:IRA POTASHNER, PSYD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTASHNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:646-575-5848
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-06
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty