Provider Demographics
NPI:1558463414
Name:BOETTINGER, DANA ANNE (CTRS)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:ANNE
Last Name:BOETTINGER
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 W CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-5318
Mailing Address - Country:US
Mailing Address - Phone:848-207-1914
Mailing Address - Fax:
Practice Address - Street 1:661 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4134
Practice Address - Country:US
Practice Address - Phone:732-450-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health