Provider Demographics
NPI:1821020553
Name:BUTLER, ANDREW C (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 GARDEN RD
Mailing Address - Street 2:STE A-102
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5366
Mailing Address - Country:US
Mailing Address - Phone:831-372-3910
Mailing Address - Fax:866-752-4401
Practice Address - Street 1:2100 GARDEN RD
Practice Address - Street 2:STE A-102
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5366
Practice Address - Country:US
Practice Address - Phone:831-372-3910
Practice Address - Fax:866-752-4401
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 20787103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02896ZMedicare UPIN