Provider Demographics
NPI:1245361138
Name:BOTTONE, ANGELA CHRISTINE (LPCMH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:BOTTONE
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 RED CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-9799
Mailing Address - Country:US
Mailing Address - Phone:302-329-9074
Mailing Address - Fax:302-261-7101
Practice Address - Street 1:112 RED CEDAR DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-9799
Practice Address - Country:US
Practice Address - Phone:302-329-9074
Practice Address - Fax:302-261-7101
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034179Medicaid
DE7687554OtherAETNA