Provider Demographics
NPI:1972975795
Name:VARLACK-BUTLER, DARRYL
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:VARLACK-BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 COMMONWEALTH AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3644
Mailing Address - Country:US
Mailing Address - Phone:631-740-1970
Mailing Address - Fax:
Practice Address - Street 1:1795 LEXINGTON AVE
Practice Address - Street 2:THE BRIDGE INC.,
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2866
Practice Address - Country:US
Practice Address - Phone:212-289-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker