Individual
KRISTIN BOTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
NEXT-559 VINCENT ST., SPACE BASE DELTA 1, PETERSON SPACE FORCE BASE, CO 80914-0000
(617) 413-6275
Mailing address
NECT-559 VINCENT STREET, SPACE BASE DELTA 1, PETERSON SFB, CO 80914
(617) 413-6275
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
116933
MA
1041C0700X
Clinical Social Worker
Primary
96216
CA
Other
Enumeration date
05/02/2008
Last updated
09/20/2023
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