Provider Demographics
NPI:1275685588
Name:BUTLER, REGINA
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 934
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2541
Mailing Address - Country:US
Mailing Address - Phone:305-892-4753
Mailing Address - Fax:305-892-4751
Practice Address - Street 1:12550 BISCAYNE BLVD
Practice Address - Street 2:SUITE 934
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2541
Practice Address - Country:US
Practice Address - Phone:305-892-4753
Practice Address - Fax:305-892-4751
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health