Provider Demographics
NPI:1912184904
Name:POTTER, KATHRYN J (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:POTTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MARKET SQ
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2497
Mailing Address - Country:US
Mailing Address - Phone:978-357-1776
Mailing Address - Fax:978-356-2822
Practice Address - Street 1:5 MARKET SQ
Practice Address - Street 2:SUITE B
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2497
Practice Address - Country:US
Practice Address - Phone:978-357-1776
Practice Address - Fax:978-356-2822
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10195171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical