Provider Demographics
NPI:1578807087
Name:BOTTIGLIO, MELISSA ANN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:BOTTIGLIO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7601 CRITTENDEN ST
Mailing Address - Street 2:APT. G-11
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3243
Mailing Address - Country:US
Mailing Address - Phone:610-952-0647
Mailing Address - Fax:610-941-5532
Practice Address - Street 1:600 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1800
Practice Address - Country:US
Practice Address - Phone:610-825-4450
Practice Address - Fax:610-941-5532
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0165161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical