Provider Demographics
NPI:1609109826
Name:POULIOT, JUNE BUTERA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:BUTERA
Last Name:POULIOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N PACE BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-5148
Mailing Address - Country:US
Mailing Address - Phone:850-390-1800
Mailing Address - Fax:850-912-4193
Practice Address - Street 1:3300 N PACE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505
Practice Address - Country:US
Practice Address - Phone:850-390-1800
Practice Address - Fax:850-912-4193
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 82651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical