Provider Demographics
NPI:1356478838
Name:BOTANA, LOURDES U (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:U
Last Name:BOTANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 SUNSET DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3245
Mailing Address - Country:US
Mailing Address - Phone:305-595-2590
Mailing Address - Fax:305-595-3746
Practice Address - Street 1:9995 SW 72ND ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4662
Practice Address - Country:US
Practice Address - Phone:305-271-0055
Practice Address - Fax:305-630-3738
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health