Provider Demographics
NPI:1588236947
Name:BOTELHO, LIAM
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:
Last Name:BOTELHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 S SILVER LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01375-9315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3275
Practice Address - Country:US
Practice Address - Phone:413-774-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228087104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker