Provider Demographics
NPI:1609801125
Name:BOLOTIN, ALAN L (LCSW)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:L
Last Name:BOLOTIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8395 KEYSTONE XING
Mailing Address - Street 2:SUITE 306
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4307
Mailing Address - Country:US
Mailing Address - Phone:317-257-7545
Mailing Address - Fax:317-257-7443
Practice Address - Street 1:8395 KEYSTONE XING
Practice Address - Street 2:SUITE 306
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4307
Practice Address - Country:US
Practice Address - Phone:317-257-7545
Practice Address - Fax:317-257-7443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004574A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical