Provider Demographics
NPI:1033262175
Name:BOTTORFF, DAN R (MDIV)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:R
Last Name:BOTTORFF
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2625
Mailing Address - Country:US
Mailing Address - Phone:908-233-0337
Mailing Address - Fax:
Practice Address - Street 1:514 GROVE ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2625
Practice Address - Country:US
Practice Address - Phone:908-233-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00125700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist