Provider Demographics
NPI:1245394014
Name:MORAN BUTTS, ENES D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ENES
Middle Name:D
Last Name:MORAN BUTTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:E BALDWIN
Mailing Address - State:ME
Mailing Address - Zip Code:04024
Mailing Address - Country:US
Mailing Address - Phone:207-787-2593
Mailing Address - Fax:
Practice Address - Street 1:381 BRIDGTON RD
Practice Address - Street 2:
Practice Address - City:SEBAGO
Practice Address - State:ME
Practice Address - Zip Code:04029
Practice Address - Country:US
Practice Address - Phone:207-787-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
O08385Medicare UPIN
MEMM4539Medicare ID - Type Unspecified