Provider Demographics
NPI:1023053360
Name:BUTSON, ERNESTINE MESHELL (MSS, LCSW, BCBA)
Entity type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:MESHELL
Last Name:BUTSON
Suffix:
Gender:F
Credentials:MSS, LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4334
Mailing Address - Country:US
Mailing Address - Phone:717-475-8385
Mailing Address - Fax:
Practice Address - Street 1:1213 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4334
Practice Address - Country:US
Practice Address - Phone:717-475-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-13-13882103K00000X
PASW123600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker