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General NPI Number Information
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NPI Number | 1881294338
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Entity Type | Organization
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Legal Business Name | PAUL J BOTTICELLI LCSW PC
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 22 SOUTHERN BLVD STE 111
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City | NESCONSET
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State | NY
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Zip | 11767-1086
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Country | US
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Telephone | 631-689-1728
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Fax |
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Provider Business Mailing Address
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Address Line | 379 POND PATH
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1020
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Country | US
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Telephone | 631-987-4817
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL BOTTICELLI
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Credential | LCSW
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Telephone | 631-689-1728
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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 |
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License Number State |
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