Provider Demographics
NPI:1316130917
Name:POTRATZ, ROBERT DENNIS (MA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DENNIS
Last Name:POTRATZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2110
Mailing Address - Country:US
Mailing Address - Phone:716-649-1031
Mailing Address - Fax:
Practice Address - Street 1:39 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1017
Practice Address - Country:US
Practice Address - Phone:585-786-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health