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General NPI Number Information
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NPI Number | 1770612384
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Entity Type | Organization
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Legal Business Name | EVELYN BOTKIN, PHD., PSYCHOLOGIST, PC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 68 VINEYARD RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-2260
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Country | US
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Telephone | 631-549-3255
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Fax | 631-549-3218
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Provider Business Mailing Address
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Address Line | 68 VINEYARD RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-2260
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Country | US
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Telephone | 631-549-3255
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Fax | 631-549-3218
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EVELYN BETTY BOTKIN
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Credential | PH.D.
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Telephone | 631-549-3255
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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 | 4634
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License Number State | NY
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