Provider Demographics
NPI:1922772847
Name:POTTINGER, ROBERTA (MSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:POTTINGER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:POTTINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2746 NW 202ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-2109
Mailing Address - Country:US
Mailing Address - Phone:305-318-4295
Mailing Address - Fax:
Practice Address - Street 1:482 S KELLER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6130
Practice Address - Country:US
Practice Address - Phone:321-397-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker