Provider Demographics
NPI:1255448486
Name:BUTLER, DAVID C (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2077
Mailing Address - Country:US
Mailing Address - Phone:315-265-4303
Mailing Address - Fax:315-265-4303
Practice Address - Street 1:30 MAIN ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2077
Practice Address - Country:US
Practice Address - Phone:315-265-4303
Practice Address - Fax:315-265-4303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006903103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist