Provider Demographics
NPI:1609319177
Name:POTTER, ERICA ANN (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:ANN
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:ANN
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:33 FERNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4899
Mailing Address - Country:US
Mailing Address - Phone:718-698-5757
Mailing Address - Fax:718-767-5928
Practice Address - Street 1:33 FERNDALE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4843
Practice Address - Country:US
Practice Address - Phone:718-698-5757
Practice Address - Fax:718-761-5928
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099117174400000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist