MEDICARE: JOHN A BOTTONE LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	001414	NY

General Provider Information

NPI Number	:	1366521858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A BOTTONE LMHC

Provider Business Mailing Address
First Line	:	26 SABBATH DAY PATH
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2752
Country	:	US
Telephone Number	:	631-423-3238
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 JERICHO TPKE
Second Line	:	SUITE LL3
City	:	COMMACK
State	:	NY
Zip	:	11725-2937
Country	:	US
Telephone Number	:	631-680-3609
Fax Number	:	631-470-0221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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