Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 44SC05190400 | NJ |
NPI | 1962557553 |
---|---|
Provider Name | Robin Marie Bottino |
First Address | Forked River, NJ 08731-1366 |
Second Address | Forked River, NJ 08731-1366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 18/09/2012 |