Provider Demographics
NPI:1518278092
Name:BUTLER-MACKAY, DENISE M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:M
Last Name:BUTLER-MACKAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:DENNIE
Other - Middle Name:M
Other - Last Name:BUTLER-MACKAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:68 WELD HILL ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4127
Mailing Address - Country:US
Mailing Address - Phone:617-835-3458
Mailing Address - Fax:
Practice Address - Street 1:640 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2555
Practice Address - Country:US
Practice Address - Phone:617-983-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10209471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical