Basic Information
| Provider Information | |||||||||
| NPI: | 1982029815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOTTI | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSSA, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10427 DETROIT AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441021645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165216511 | ||||||||
| FaxNumber: | 2165216006 | ||||||||
| Practice Location | |||||||||
| Address1: | 10427 DETROIT AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441021645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165216511 | ||||||||
| FaxNumber: | 2165216006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2014 | ||||||||
| LastUpdateDate: | 03/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1430092 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.