=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043611841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YASMIN ROSE BOTTE LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2014
-----------------------------------------------------
Last Update Date | 11/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 345 GUYON AVENUE ROOM 14
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10306-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-948-5077
-----------------------------------------------------
Fax | 347-394-2152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 526 AMHERST AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10306-5325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-948-5077
-----------------------------------------------------
Fax | 347-394-2152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------