Provider Demographics
NPI:1851623821
Name:BOTNICK, LEORA BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEORA
Middle Name:BETH
Last Name:BOTNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1138
Mailing Address - Country:US
Mailing Address - Phone:718-918-6706
Mailing Address - Fax:718-918-3480
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:1B2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5657
Practice Address - Fax:718-579-5310
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0762691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical