Provider Demographics
NPI:1558986331
Name:BUTLER, LAUREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 RIDGELY AVE
Mailing Address - Street 2:ATTN: LAUREN BUTLER, PSYD
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:619-538-4750
Mailing Address - Fax:
Practice Address - Street 1:611 RIDGELY AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1069
Practice Address - Country:US
Practice Address - Phone:619-538-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31194103TC0700X
MD06577103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical