Provider Demographics
NPI:1700958774
Name:POTASH, ALBERT GEORGE (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:GEORGE
Last Name:POTASH
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON ST STE 217
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6017
Mailing Address - Country:US
Mailing Address - Phone:310-463-6638
Mailing Address - Fax:310-373-4564
Practice Address - Street 1:24050 MADISON ST STE 217
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6017
Practice Address - Country:US
Practice Address - Phone:310-463-6638
Practice Address - Fax:310-373-4564
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist