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General NPI Number Information
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NPI Number | 1407556822
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Entity Type | Organization
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Legal Business Name | LISA BOTTICELLI, PH.D. PSYCHOLOGY, P.L.L.C.
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 70 MIDDAGH ST # 2A
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City | BROOKLYN
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State | NY
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Zip | 11201-1384
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Country | US
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Telephone | 203-451-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 5TH AVE APT 32C
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City | NEW YORK
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State | NY
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Zip | 10029-5250
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | DR. LISA MARIE BOTTICELLI
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Credential | PH.D.
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Telephone | 203-451-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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