Provider Demographics
NPI:1841406360
Name:BOTTORFF, SUSAN BROWN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BROWN
Last Name:BOTTORFF
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2625
Mailing Address - Country:US
Mailing Address - Phone:908-233-0337
Mailing Address - Fax:
Practice Address - Street 1:514 GROVE ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2625
Practice Address - Country:US
Practice Address - Phone:908-233-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008639001041C0700X
NYR027659-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ655817AC3Medicare ID - Type Unspecified