Provider Demographics
NPI:1184858441
Name:BUTTERFLY CLINICAL INC.
Entity Type:Organization
Organization Name:BUTTERFLY CLINICAL INC.
Other - Org Name:JEAN BACON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-666-1951
Mailing Address - Street 1:250 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8337
Mailing Address - Country:US
Mailing Address - Phone:631-666-1951
Mailing Address - Fax:
Practice Address - Street 1:250 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8337
Practice Address - Country:US
Practice Address - Phone:631-666-1951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070508104100000X
NY073889104100000X
NY077805104100000X
NY075977104100000X
NY079551104100000X
NY076780104100000X
NY074014104100000X
NY076163104100000X
NY079274104100000X
NY070271104100000X
NY0450561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty