Provider Demographics
NPI:1497114987
Name:BOTEV, RADOSLAV (MS)
Entity Type:Individual
Prefix:
First Name:RADOSLAV
Middle Name:
Last Name:BOTEV
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2803
Mailing Address - Country:US
Mailing Address - Phone:727-895-8499
Mailing Address - Fax:727-895-8497
Practice Address - Street 1:433 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2803
Practice Address - Country:US
Practice Address - Phone:727-895-8499
Practice Address - Fax:727-895-8497
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH17730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health