Provider Demographics
NPI:1134543655
Name:POTTINGER, CHERYLEE
Entity type:Individual
Prefix:
First Name:CHERYLEE
Middle Name:
Last Name:POTTINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5465
Mailing Address - Country:US
Mailing Address - Phone:718-551-3559
Mailing Address - Fax:
Practice Address - Street 1:1143 47TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5465
Practice Address - Country:US
Practice Address - Phone:718-551-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker