Individual
THERESA C POTENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
920 60TH ST, KENOSHA, WI 53140-4041
(262) 654-5333
(262) 654-7818
Mailing address
920 60TH ST, KENOSHA, WI 53140-4041
(262) 654-5333
(262) 654-7818
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2933-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137897
MANAGED HEALTH NETWORK
—
01
—
209736
VALUE OPTIONS
—
05
—
39501700
—
WI
01
—
5616139
AETNA
—
01
—
79757
UNITED BEHAVIORAL HEALTH
—
01
—
W009308
TRICARE CHAMPUS
—
Enumeration date
12/15/2006
Last updated
07/08/2007
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