Provider Demographics
NPI:1891918587
Name:BILLOTTI, PATRICIA (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BILLOTTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 POWDER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-3215
Mailing Address - Country:US
Mailing Address - Phone:201-447-0951
Mailing Address - Fax:
Practice Address - Street 1:71 FRANKLIN TPKE
Practice Address - Street 2:SUITE 1-8
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1851
Practice Address - Country:US
Practice Address - Phone:201-447-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC50112364SP0808X
NY000815102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB1601730Medicare ID - Type Unspecified