Provider Demographics
NPI:1194938506
Name:POTUCEK, MAUREEN KATHRYN
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:KATHRYN
Last Name:POTUCEK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MAUREEN
Other - Middle Name:KATHRYN
Other - Last Name:ONEILL-POTUCEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3555 E FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2972
Mailing Address - Country:US
Mailing Address - Phone:520-515-2790
Mailing Address - Fax:520-515-2726
Practice Address - Street 1:3555 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2972
Practice Address - Country:US
Practice Address - Phone:520-515-2790
Practice Address - Fax:520-515-2726
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool