Provider Demographics
NPI:1629480447
Name:BOTTINO, LILIA (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:BOTTINO
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PEGASUS ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-5028
Mailing Address - Country:US
Mailing Address - Phone:207-798-3922
Mailing Address - Fax:
Practice Address - Street 1:62 PEGASUS ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-5028
Practice Address - Country:US
Practice Address - Phone:207-798-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical