Provider Demographics
NPI:1750746558
Name:POTTER, RYAN (LCSW, MCAP)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:POTTER
Suffix:
Gender:M
Credentials:LCSW, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310A E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3257
Mailing Address - Country:US
Mailing Address - Phone:561-531-9898
Mailing Address - Fax:
Practice Address - Street 1:8800 SUNSET DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6233
Practice Address - Country:US
Practice Address - Phone:561-531-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW123511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical