Provider Demographics
NPI:1164632683
Name:BOTKIN, MERYL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:MERYL
Middle Name:J
Last Name:BOTKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PIERCE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3108
Mailing Address - Country:US
Mailing Address - Phone:415-922-8966
Mailing Address - Fax:
Practice Address - Street 1:1700 PIERCE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3108
Practice Address - Country:US
Practice Address - Phone:415-922-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13086103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL13860Medicare ID - Type UnspecifiedMEDICARE NUMBER