Provider Demographics
NPI:1164593786
Name:BUTLER MINOR, MARY ELIZABETH (MED IN COUNSELING)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BUTLER MINOR
Suffix:
Gender:F
Credentials:MED IN COUNSELING
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 VICTORY RD
Mailing Address - Street 2:SOUTH SHORE MENTAL HEALTH
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171
Mailing Address - Country:US
Mailing Address - Phone:617-847-1950
Mailing Address - Fax:617-774-1490
Practice Address - Street 1:572 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673
Practice Address - Country:US
Practice Address - Phone:508-775-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical