Provider Demographics
NPI:1225091259
Name:BOTTORFF, CLIFFORD J
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:J
Last Name:BOTTORFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 HOSPITAL DR
Mailing Address - Street 2:SUTIE 201
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-4178
Mailing Address - Country:US
Mailing Address - Phone:804-693-0810
Mailing Address - Fax:804-693-0211
Practice Address - Street 1:7580 HOSPITAL DR
Practice Address - Street 2:SUTIE 201
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4178
Practice Address - Country:US
Practice Address - Phone:804-693-0810
Practice Address - Fax:804-693-0211
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040014751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical