Provider Demographics
NPI:1750561155
Name:POTTERTON, LINDSAY ALISA (LCSW)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ALISA
Last Name:POTTERTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ALISA
Other - Last Name:POTTERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:202 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1834
Mailing Address - Country:US
Mailing Address - Phone:860-995-3275
Mailing Address - Fax:
Practice Address - Street 1:281 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1823
Practice Address - Country:US
Practice Address - Phone:860-569-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT94141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical