Provider Demographics
NPI:1306167242
Name:BOTWIN, MATTHEW WILLIAM (LCSW, MA, DWP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:BOTWIN
Suffix:
Gender:M
Credentials:LCSW, MA, DWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADWAY
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3054
Mailing Address - Country:US
Mailing Address - Phone:212-227-1867
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:SUITE 3400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3054
Practice Address - Country:US
Practice Address - Phone:212-227-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079032-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical