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General NPI Number Information
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NPI Number | 1023175171
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Entity Type | Individual
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Provider Name | SUSAN MARY BOTELLO MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 275 MILLWAY
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City | BARNSTABLE
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State | MA
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Zip | 02630-1102
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Country | US
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Telephone | 508-375-0080
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Fax | 508-375-0083
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Provider Business Mailing Address
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Address Line | 275 MILLWAY P.O. BOX 1030
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City | BARNSTABLE
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State | MA
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Zip | 02630-1102
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Country | US
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Telephone | 508-375-0080
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Fax | 508-375-0083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 110310
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License Number State | MA
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