Provider Demographics
NPI:1902354830
Name:POTOZNEY, CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:POTOZNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 STUYVESANT AVE
Mailing Address - Street 2:16B
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1441
Mailing Address - Country:US
Mailing Address - Phone:201-390-7460
Mailing Address - Fax:
Practice Address - Street 1:543 VALLEY RD STE 9
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1844
Practice Address - Country:US
Practice Address - Phone:732-902-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PCOO441200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional