Provider Demographics
NPI:1386762219
Name:POTENZIANO, KAREN SCUTT (MSW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SCUTT
Last Name:POTENZIANO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 ROYAL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04097-6911
Mailing Address - Country:US
Mailing Address - Phone:207-939-4369
Mailing Address - Fax:
Practice Address - Street 1:196 ALLEN AVE
Practice Address - Street 2:CASCO BAY HIGH SCHOOL
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3711
Practice Address - Country:US
Practice Address - Phone:207-939-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC61161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical