MEDICARE: DENISE BOTCHEOS

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	1041C0700X	Clinical Social Worker	44SC05998600	NJ
2	1041C0700X	Clinical Social Worker	CW018865	PA

General Provider Information

NPI Number	:	1457014706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE BOTCHEOS

Provider Business Mailing Address
First Line	:	2138 S MOLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2138 S MOLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3915
Country	:	US
Telephone Number	:	267-354-0392
Fax Number	:

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

Provider Enumeration Date	:	10/14/2021
Last Update Date	:	10/14/2021

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Directions to “ DENISE BOTCHEOS ” Practice Location

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