Provider Demographics
NPI:1336313998
Name:BUTTERFIELD, PENELOPE ANNE
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:ANNE
Last Name:BUTTERFIELD
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 1:411 KING ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4323
Mailing Address - Country:US
Mailing Address - Phone:707-569-0877
Mailing Address - Fax:707-569-0111
Practice Address - Street 1:411 KING ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4323
Practice Address - Country:US
Practice Address - Phone:707-569-0877
Practice Address - Fax:707-569-0111
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health