Provider Demographics
NPI:1518681352
Name:BUTCHER, IRAIRA
Entity Type:Individual
Prefix:
First Name:IRAIRA
Middle Name:
Last Name:BUTCHER
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:PTY 31252
Mailing Address - Street 2:PO BOX 025724
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33102
Mailing Address - Country:US
Mailing Address - Phone:718-615-5523
Mailing Address - Fax:
Practice Address - Street 1:BRISAS DEL GOLF CALLE 11 OCCIIDENTAL CASA A026
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:PANAMA
Practice Address - Zip Code:33102
Practice Address - Country:PA
Practice Address - Phone:718-615-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty