Provider Demographics
NPI:1316587249
Name:VENZEN-POTTER, PAULETTE MADELINE
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:MADELINE
Last Name:VENZEN-POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 ESTATE TUTU VLY
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1744
Mailing Address - Country:US
Mailing Address - Phone:340-998-1858
Mailing Address - Fax:
Practice Address - Street 1:1619 SIXTH ST
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2635
Practice Address - Country:US
Practice Address - Phone:340-777-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1-23450-1B104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker