Healthcare Provider Details

I. General information

NPI: 1588729024
Provider Name (Legal Business Name): ARIEL A BOTTA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

98 CHARLES ST
BOSTON MA
02114-4610
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6710
  • Fax: 617-730-0319
Mailing address:
  • Phone: 857-891-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111066
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number111066
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: