Organization
POTENZA PSYCHOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA BUTTACAVOLI-SMITH PHD (OWNER)
(410) 929-1719
Entity
Organization
Contact information
Practice address
10 E MOUNT VERNON PL, BALTIMORE, MD 21202-2309
(410) 929-1719
(410) 929-1719
Mailing address
4021 ROLAND AVE, BALTIMORE, MD 21211-2032
(253) 569-5383
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649627480
—
MD
Enumeration date
10/10/2017
Last updated
10/10/2017
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