Doctor Name: | KAREN BOTTALICO |
NPI Number: | 1285828046 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 189 Wheatley Rd Children's Education Center Glen Head, NY - 115452641 |
Business Phone Number: | 5166261075 |
Business Fax Number: | |
Mailing Address: | 189 Wheatley Rd, Children's Education Center GLEN HEAD |
State: | NY |
Postal Code: | 115452641 |
Phone Number: | 5166261075 |
Fax Number: | |
NPI Enumeration Date: | 09/04/2007 |
NPI Last Update Date: | 09/04/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |