Active NPI
Carla C Potter, MSSW, LCSW
- Clinical Social Worker
- Slate Hill, NY
National Provider Identifier
1639294903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R-20600-1
- Practice address
- 523 Ridgebury Rd
Slate Hill, NY 10973-4310 - Phone
- (845) 355-1092
- Fax
- (845) 355-6535
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R-20600-1 | NY | Primary |
Addresses
Primary practice location
523 Ridgebury Rd
Slate Hill, NY 10973-4310
Mailing address
523 Ridgebury Rd
Slate Hill, NY 10973-4310
Phone (845) 355-1092
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5459553 | Other | NY | AETNA |
| 136227 | Other | NY | VALUE OPTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-20600-1 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Potter Counseling and Evaluation Service, CSW, PC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Slate Hill, NY
- NPI 1871618157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294272000000",
"number": "1639294903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "523 RIDGEBURY RD",
"city": "SLATE HILL",
"state": "NY",
"postal_code": "109734310",
"telephone_number": "845-355-1092",
"fax_number": "845-355-6535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "523 RIDGEBURY RD",
"city": "SLATE HILL",
"state": "NY",
"postal_code": "109734310",
"telephone_number": "845-355-1092",
"fax_number": "845-355-6535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "CARLA",
"middle_name": "C",
"name_prefix": "Ms.",
"credential": "MSSW, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2011-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R-20600-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5459553",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "136227",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Slate Hill, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.