Provider Demographics
NPI:1568829588
Name:BUTSICK, HAVILAH
Entity Type:Individual
Prefix:
First Name:HAVILAH
Middle Name:
Last Name:BUTSICK
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 1:583 SHOEMAKER RD
Mailing Address - Street 2:SUITE230
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4201
Mailing Address - Country:US
Mailing Address - Phone:484-681-2170
Mailing Address - Fax:484-320-8307
Practice Address - Street 1:583 SHOEMAKER RD
Practice Address - Street 2:SUITE230
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4201
Practice Address - Country:US
Practice Address - Phone:484-681-2170
Practice Address - Fax:484-320-8307
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst