Provider Demographics
NPI:1467786525
Name:PINOU-BUTKA, CAROLE JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:JEAN
Last Name:PINOU-BUTKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4325
Mailing Address - Country:US
Mailing Address - Phone:516-326-1501
Mailing Address - Fax:
Practice Address - Street 1:7164 168TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-3242
Practice Address - Country:US
Practice Address - Phone:718-591-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285770891103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool