Provider Demographics
NPI:1063414423
Name:BOTZER, ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:BOTZER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4373 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NY
Mailing Address - Zip Code:14172
Mailing Address - Country:US
Mailing Address - Phone:716-867-0280
Mailing Address - Fax:716-636-4501
Practice Address - Street 1:4373 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172
Practice Address - Country:US
Practice Address - Phone:716-867-0280
Practice Address - Fax:716-636-4501
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016059-1103T00000X
NY016059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist