Provider Demographics
NPI:1700894565
Name:POTTS, STARR BOGGS (MSW)
Entity type:Individual
Prefix:MS
First Name:STARR
Middle Name:BOGGS
Last Name:POTTS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:STARR
Other - Middle Name:B
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:10 AMIDON DR
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06278-2003
Mailing Address - Country:US
Mailing Address - Phone:508-655-8331
Mailing Address - Fax:508-655-8331
Practice Address - Street 1:317 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1115
Practice Address - Country:US
Practice Address - Phone:508-655-8331
Practice Address - Fax:508-655-8331
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4443OtherBLUE CROSS/BLUE SHIELD
MAPO4443OtherBLUE CROSS/BLUE SHIELD