Provider Demographics
NPI:1639382252
Name:BOTKIN, ALLAN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:L
Last Name:BOTKIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 HARMS AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2524
Mailing Address - Country:US
Mailing Address - Phone:847-680-0279
Mailing Address - Fax:
Practice Address - Street 1:1144 HARMS AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2524
Practice Address - Country:US
Practice Address - Phone:847-680-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical