Healthcare Provider Details

I. General information

NPI: 1386912772
Provider Name (Legal Business Name): ELIZABETH MARIA BOTERO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EDUCATION DR
BEACON NY
12508-4066
US

IV. Provider business mailing address

619 KISSAM RD
PEEKSKILL NY
10566-2472
US

V. Phone/Fax

Practice location:
  • Phone: 845-838-6900
  • Fax: 845-838-6976
Mailing address:
  • Phone: 914-844-4789
  • Fax: 914-402-5473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number051147-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: