1659504348 NPI number — J. BROOKS AND ASSOCIATES

Table of content: MS. DEBRA LYNN POTTER DPT (NPI 1275773806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659504348 NPI number — J. BROOKS AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. BROOKS AND ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659504348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5203 N CHARLES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21210-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-402-4564
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 VILLAGE SQ
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21210-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-402-4564
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JONES-BROOKS
Authorized Official First Name:
TAMRA
Authorized Official Middle Name:
CHANEL
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
410-402-4564

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  04496 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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