Provider Demographics
NPI:1255571907
Name:BUTLER, MICHELLE M (MSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1906
Mailing Address - Country:US
Mailing Address - Phone:528-831-0045
Mailing Address - Fax:507-753-5051
Practice Address - Street 1:105 MERRICK ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1937
Practice Address - Country:US
Practice Address - Phone:508-797-6100
Practice Address - Fax:528-797-0693
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308785Medicaid
MA2220002001OtherBCBS
MAM18684OtherBCBS
MA1306421Medicaid
MA1306421Medicaid