Provider Demographics
NPI:1427397017
Name:BOTSARIS, LYNN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:BOTSARIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 STILES RD
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1548
Mailing Address - Country:US
Mailing Address - Phone:774-364-1880
Mailing Address - Fax:
Practice Address - Street 1:107 STILES RD
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1548
Practice Address - Country:US
Practice Address - Phone:774-364-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical