Healthcare Provider Details

I. General information

NPI: 1174734370
Provider Name (Legal Business Name): ROSVITA N.A. BOTKIN PH.D., LMHC.,LPAT.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 LEJANO LN
SANTA FE NM
87501-8749
US

IV. Provider business mailing address

1310 LEJANO LN
SANTA FE NM
87501-8749
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-2601
  • Fax: 505-988-2601
Mailing address:
  • Phone: 505-988-2601
  • Fax: 505-988-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0263
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: