Provider Demographics
NPI:1205330230
Name:BUTLER, JACQUELINE (LICSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VINSON CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3255
Mailing Address - Country:US
Mailing Address - Phone:978-882-5831
Mailing Address - Fax:
Practice Address - Street 1:CARE DIMENSIONS
Practice Address - Street 2:125 WINTER STREET
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773
Practice Address - Country:US
Practice Address - Phone:888-728-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10314081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical