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General NPI Number Information
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NPI Number | 1578819447
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Entity Type | Individual
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Provider Name | THOMAS JAMES BOTTLE LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 7 CLAYTON AVE
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City | CORTLAND
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State | NY
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Zip | 13045-2501
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Country | US
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Telephone | 607-428-5463
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Fax | 607-758-6116
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Provider Business Mailing Address
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Address Line | 38 W ACADEMY ST
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City | MC GRAW
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State | NY
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Zip | 13101-9424
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Country | US
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Telephone | 607-237-1863
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Fax |
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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 | 088032-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 082884-1
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License Number State | NY
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