Provider Demographics
NPI:1063101863
Name:POTENZA WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:POTENZA WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARITAL & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTENZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-307-0190
Mailing Address - Street 1:66 HUNTINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5250
Mailing Address - Country:US
Mailing Address - Phone:203-307-0190
Mailing Address - Fax:
Practice Address - Street 1:66 HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5250
Practice Address - Country:US
Practice Address - Phone:203-307-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty