Provider Demographics
NPI:1184999724
Name:MASTER POTTER INC.
Entity type:Organization
Organization Name:MASTER POTTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:KWENTUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-675-6153
Mailing Address - Street 1:11302 POLARIS DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-675-6153
Mailing Address - Fax:
Practice Address - Street 1:11302 POLARIS DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-3539
Practice Address - Country:US
Practice Address - Phone:301-675-6153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASTER POTTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health