Provider Demographics
NPI:1598869083
Name:BUTTERFIELD, BRUCE JOHN (LCSW)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JOHN
Last Name:BUTTERFIELD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10712 LAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5110
Mailing Address - Country:US
Mailing Address - Phone:708-636-4469
Mailing Address - Fax:
Practice Address - Street 1:10712 LAVERGNE AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5110
Practice Address - Country:US
Practice Address - Phone:708-636-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical