Healthcare Provider Details

I. General information

NPI: 1578807087
Provider Name (Legal Business Name): MELISSA ANN BOTTIGLIO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1800
US

IV. Provider business mailing address

7601 CRITTENDEN ST APT. G-11
PHILADELPHIA PA
19118-3243
US

V. Phone/Fax

Practice location:
  • Phone: 610-825-4450
  • Fax: 610-941-5532
Mailing address:
  • Phone: 610-952-0647
  • Fax: 610-941-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016516
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: