Provider Demographics
NPI:1962557553
Name:BOTTINO, ROBIN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:BOTTINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MANCHESTER AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1366
Mailing Address - Country:US
Mailing Address - Phone:609-971-7060
Mailing Address - Fax:
Practice Address - Street 1:34 MANCHESTER AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1366
Practice Address - Country:US
Practice Address - Phone:609-971-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051904001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical