Provider Demographics
NPI:1275153421
Name:BUTERA, JACLYN MARIA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:MARIA
Last Name:BUTERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DELNO DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-3423
Mailing Address - Country:US
Mailing Address - Phone:914-441-1651
Mailing Address - Fax:
Practice Address - Street 1:16 SCHOOL ST STE B
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2952
Practice Address - Country:US
Practice Address - Phone:914-441-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0464261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical