Provider Demographics
NPI:1568153427
Name:BOOTY, SENECA LYNN
Entity Type:Individual
Prefix:
First Name:SENECA
Middle Name:LYNN
Last Name:BOOTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1946
Mailing Address - Country:US
Mailing Address - Phone:330-503-2184
Mailing Address - Fax:
Practice Address - Street 1:130 W NORTH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3906
Practice Address - Country:US
Practice Address - Phone:724-658-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027186363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health