Healthcare Provider Details

I. General information

NPI: 1336051440
Provider Name (Legal Business Name): KRISTIN BOTWINICK LCSW-R
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 SPLIT ROCK RD
CAMILLUS NY
13031-9724
US

IV. Provider business mailing address

3810 SPLIT ROCK RD
CAMILLUS NY
13031-9724
US

V. Phone/Fax

Practice location:
  • Phone: 315-466-6573
  • Fax:
Mailing address:
  • Phone: 315-466-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN BOTWINICK
Title or Position: OWNER
Credential:
Phone: 315-466-6573