Basic Information
| Provider Information | |||||||||
| NPI: | 1427356815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POTTER | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 DANIEL SHAYS HWY UNIT 6 | ||||||||
| Address2: | |||||||||
| City: | BELCHERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010078920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136276066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 AMITY ST | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135851300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2011 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 118987 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.