Provider Demographics
NPI:1619167806
Name:BUTTERWORTH, CAROLYN A (MSRDRN)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:A
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:MSRDRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 2ND AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1133
Mailing Address - Country:US
Mailing Address - Phone:781-466-8967
Mailing Address - Fax:781-466-8987
Practice Address - Street 1:40 2ND AVE STE 340
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1133
Practice Address - Country:US
Practice Address - Phone:781-466-8967
Practice Address - Fax:781-466-8987
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA639133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric