Provider Demographics
NPI:1922183847
Name:BUTTERWORTH, MAUREEN (LISW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 TUSCARORA AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1139
Mailing Address - Country:US
Mailing Address - Phone:843-522-8681
Mailing Address - Fax:
Practice Address - Street 1:106 WEST ST. EXTENSION
Practice Address - Street 2:SUITE B
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-8502
Practice Address - Country:US
Practice Address - Phone:843-524-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health