Provider Demographics
NPI:1942770375
Name:BOTTORFF, DAWN RAE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:RAE
Last Name:BOTTORFF
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:RAE
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3706 WHITE PINE RD APT E
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3232
Mailing Address - Country:US
Mailing Address - Phone:574-533-2634
Mailing Address - Fax:
Practice Address - Street 1:12039 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3042
Practice Address - Country:US
Practice Address - Phone:410-527-5000
Practice Address - Fax:410-833-4102
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12648OtherDHMH