Provider Demographics
NPI:1578799755
Name:POTOFF, CARRIE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:POTOFF
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 1:157 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-1946
Mailing Address - Country:US
Mailing Address - Phone:860-985-8981
Mailing Address - Fax:
Practice Address - Street 1:157 ESSEX ST
Practice Address - Street 2:
Practice Address - City:DEEP RIVER
Practice Address - State:CT
Practice Address - Zip Code:06417-1946
Practice Address - Country:US
Practice Address - Phone:860-985-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0073211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical