Provider Demographics
NPI:1174734370
Name:BOTKIN, ROSVITA NA (PHD, LMHC,LPAT,)
Entity type:Individual
Prefix:
First Name:ROSVITA
Middle Name:NA
Last Name:BOTKIN
Suffix:
Gender:F
Credentials:PHD, LMHC,LPAT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 LEJANO LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-8749
Mailing Address - Country:US
Mailing Address - Phone:505-988-2601
Mailing Address - Fax:505-988-2601
Practice Address - Street 1:1310 LEJANO LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-8749
Practice Address - Country:US
Practice Address - Phone:505-988-2601
Practice Address - Fax:505-988-2601
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health