Provider Demographics
NPI:1255602025
Name:THE POTTER'S PLACE
Entity type:Organization
Organization Name:THE POTTER'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC,CASAC
Authorized Official - Phone:315-771-8322
Mailing Address - Street 1:210 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4546
Mailing Address - Country:US
Mailing Address - Phone:315-212-4381
Mailing Address - Fax:315-212-4382
Practice Address - Street 1:210 COURT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4546
Practice Address - Country:US
Practice Address - Phone:315-212-4381
Practice Address - Fax:315-212-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty