Provider Demographics
NPI:1023480423
Name:POTTER, AMANDA (LICSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:DUBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 REED AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1912
Mailing Address - Country:US
Mailing Address - Phone:401-525-0576
Mailing Address - Fax:
Practice Address - Street 1:34 SCHOOL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2339
Practice Address - Country:US
Practice Address - Phone:508-543-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-24
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1174851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical