Provider Demographics
NPI:1134292907
Name:BOTTONE, JOSEPHINE ANNE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:ANNE
Last Name:BOTTONE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5885
Mailing Address - Country:US
Mailing Address - Phone:978-264-4003
Mailing Address - Fax:
Practice Address - Street 1:930 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5885
Practice Address - Country:US
Practice Address - Phone:978-264-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1056021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical