Provider Demographics
NPI:1386912772
Name:BOTERO, ELIZABETH MARIA (LMSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:BOTERO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 KISSAM RD
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2472
Mailing Address - Country:US
Mailing Address - Phone:914-844-4789
Mailing Address - Fax:914-402-5473
Practice Address - Street 1:10 EDUCATION DR
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-4066
Practice Address - Country:US
Practice Address - Phone:845-838-6900
Practice Address - Fax:845-838-6976
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051147-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical