| Doctor Name: | SANDRA G BOTHWICK |
| NPI Number: | 1225089212 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 1029843 |
| Business Practice Address: | 540 Meadow Street Ext Suite 101 Agawam, MA - 010012035 |
| Business Phone Number: | 4137897455 |
| Business Fax Number: | |
| Mailing Address: | 1035 Sumner Ave, SPRINGFIELD |
| State: | MA |
| Postal Code: | 011182147 |
| Phone Number: | 4137343154 |
| Fax Number: | |
| NPI Enumeration Date: | 05/14/2006 |
| NPI Last Update Date: | 09/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 1029843 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |