Provider Demographics
NPI:1316240724
Name:BOTTEGAL, JENNIFER L (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BOTTEGAL
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 PHILADELPHIA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3941
Mailing Address - Country:US
Mailing Address - Phone:724-465-2605
Mailing Address - Fax:
Practice Address - Street 1:665 PHILADELPHIA ST STE 202
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3941
Practice Address - Country:US
Practice Address - Phone:724-465-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker