Provider Demographics
NPI:1538210620
Name:POTTER, NORMAN L (LCSW)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:L
Last Name:POTTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:HHC ,18TH MEDCOM
Mailing Address - Street 2:BOX 729, UNIT 15244
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205
Mailing Address - Country:KR
Mailing Address - Phone:011-822-7917
Mailing Address - Fax:0118227-917-5029
Practice Address - Street 1:HHC ,18TH MEDCOM
Practice Address - Street 2:BOX 729, UNIT 15244
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:KR
Practice Address - Phone:011-822-7917
Practice Address - Fax:0118227-917-5029
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5190626-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical