Provider Demographics
NPI:1598060717
Name:POTTER, ANNE ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:ELIZABETH
Last Name:POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANNE
Other - Middle Name:ELIZABETH
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:20A FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4804
Mailing Address - Country:US
Mailing Address - Phone:207-947-8285
Mailing Address - Fax:
Practice Address - Street 1:20A FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4804
Practice Address - Country:US
Practice Address - Phone:207-947-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC128691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical