Provider Demographics
NPI:1184749046
Name:POTESHMAN, HELENA MICA (PSYD)
Entity type:Individual
Prefix:MS
First Name:HELENA
Middle Name:MICA
Last Name:POTESHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:HELENA
Other - Middle Name:MICA
Other - Last Name:EDMONDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4727 WILLIS AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2685
Mailing Address - Country:US
Mailing Address - Phone:818-984-6565
Mailing Address - Fax:
Practice Address - Street 1:4727 WILLIS AVE APT 207
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2685
Practice Address - Country:US
Practice Address - Phone:818-984-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB31242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical