Provider Demographics
NPI:1669709119
Name:BOTWINICK, ALYCE (LCSW)
Entity type:Individual
Prefix:
First Name:ALYCE
Middle Name:
Last Name:BOTWINICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10642 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4525
Mailing Address - Country:US
Mailing Address - Phone:310-470-9016
Mailing Address - Fax:310-470-3169
Practice Address - Street 1:10642 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4525
Practice Address - Country:US
Practice Address - Phone:310-470-9016
Practice Address - Fax:310-470-3169
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 162351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical