Provider Demographics
NPI:1558600353
Name:BUTLER, TONIANN (MSW)
Entity Type:Individual
Prefix:
First Name:TONIANN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 HAMPTON POINT DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4881
Mailing Address - Country:US
Mailing Address - Phone:954-651-8920
Mailing Address - Fax:
Practice Address - Street 1:6811 KENILWORTH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1333
Practice Address - Country:US
Practice Address - Phone:301-699-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6365104100000X
DC50079864253J00000X
MD19396253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No104100000XBehavioral Health & Social Service ProvidersSocial Worker