Provider Demographics
NPI:1962808642
Name:BOTWINICK, ADIRA LAUTMAN (LMSW)
Entity type:Individual
Prefix:
First Name:ADIRA
Middle Name:LAUTMAN
Last Name:BOTWINICK
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 1:56 BENNETT AVE
Mailing Address - Street 2:4J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2146
Mailing Address - Country:US
Mailing Address - Phone:216-952-7700
Mailing Address - Fax:
Practice Address - Street 1:56 BENNETT AVE
Practice Address - Street 2:4J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2146
Practice Address - Country:US
Practice Address - Phone:216-952-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY91424104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker