Provider Demographics
NPI:1649771627
Name:DANA BOTTARI LCSW LLC
Entity Type:Organization
Organization Name:DANA BOTTARI LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTARI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-203-0804
Mailing Address - Street 1:3120 E LATITUDE CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-8062
Mailing Address - Country:US
Mailing Address - Phone:561-203-0804
Mailing Address - Fax:
Practice Address - Street 1:4731 W ATLANTIC AVE STE B21
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3897
Practice Address - Country:US
Practice Address - Phone:561-203-0804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)