| Paul J Botticelli Lcsw Pc | |
|
24 Willow Dr Coram NY 11727-4147 | |
| (631) 987-4817 | |
| Not Available |
| Full Name | Paul J Botticelli Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 24 Willow Dr, Coram, New York |
| Authorized Official Name and Position | Paul Botticelli (PRESIDENT) |
| Authorized Official Contact | 6319874817 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul J Botticelli Lcsw Pc 24 Willow Dr Coram NY 11727-4147 Ph: (631) 987-4817 | Paul J Botticelli Lcsw Pc 24 Willow Dr Coram NY 11727-4147 Ph: (631) 987-4817 |
| NPI Number | 1881294338 |
|---|---|
| Provider Enumeration Date | 10/26/2020 |
| Last Update Date | 03/03/2026 |
| Certification Date | 03/03/2026 |
| Medicare PECOS PAC ID | 1850792516 |
|---|---|
| Medicare Enrollment ID | O20210701001657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881294338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Paul J Botticelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457499808 PECOS PAC ID: 7517926702 Enrollment ID: I20041004001061 |
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