Provider Demographics
NPI:1184728636
Name:BUTLER, CAROL A (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W 13TH ST
Mailing Address - Street 2:LB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7959
Mailing Address - Country:US
Mailing Address - Phone:212-807-0008
Mailing Address - Fax:212-675-7073
Practice Address - Street 1:60 W 13TH ST
Practice Address - Street 2:LB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7959
Practice Address - Country:US
Practice Address - Phone:212-807-0008
Practice Address - Fax:212-675-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000561103TP0814X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst