Provider Demographics
NPI:1861162307
Name:BOTKO, BROOKE (MSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BOTKO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21374 FALLS RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4870
Mailing Address - Country:US
Mailing Address - Phone:561-702-1522
Mailing Address - Fax:
Practice Address - Street 1:6971 N FEDERAL HWY STE 206
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1648
Practice Address - Country:US
Practice Address - Phone:561-408-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health