Potente, Theresa C

Potente, Theresa C is an individual health care provider with primary practice located at 920 60Th St , Kenosha WI 53140-4041. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Potente, Theresa C can be contacted via phone (262) 654-5333.

Contact Information

Primary practice address
920 60Th St Kenosha WI 53140-4041
Phone: (262) 654-5333
Fax: (262) 654-7818
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 2933-123 Wisconsin

Profile Details

NPI number 1912069667
LBN Legal business name Potente, Theresa C
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 15th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912069667 NPPES
Other 209736 VALUE OPTIONS
Other 79757 VALUE OPTIONS
Other W009308 VALUE OPTIONS
MEDICAID 39501700 VALUE OPTIONS
Other 5616139 VALUE OPTIONS
Other 137897 VALUE OPTIONS

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