Provider Demographics
NPI:1689070054
Name:BARBUTO, TINA MARIE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:BARBUTO
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 1:110NW 135TH WAY
Mailing Address - Street 2:UNIT 46-204
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-7703
Mailing Address - Country:US
Mailing Address - Phone:315-254-0715
Mailing Address - Fax:
Practice Address - Street 1:110NW135TH WAY
Practice Address - Street 2:APT 46-204
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33325-7703
Practice Address - Country:US
Practice Address - Phone:315-254-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12689101YM0800X
NY005768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health