Provider Demographics
NPI:1578945838
Name:POTHEMONT, DONNA MAUREEN (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:MAUREEN
Last Name:POTHEMONT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3208
Mailing Address - Country:US
Mailing Address - Phone:914-699-9384
Mailing Address - Fax:
Practice Address - Street 1:141 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3208
Practice Address - Country:US
Practice Address - Phone:914-699-9384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094048104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker