Provider Demographics
NPI:1821384355
Name:POTTS, LINDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:POTTS
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 1:4937 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478-3526
Mailing Address - Country:US
Mailing Address - Phone:315-361-8400
Mailing Address - Fax:
Practice Address - Street 1:4937 SPRING RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-3526
Practice Address - Country:US
Practice Address - Phone:315-361-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY251300000XMedicaid