Provider Demographics
NPI:1295710374
Name:BUTTNER, DOREEN E (LCSW)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:E
Last Name:BUTTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:E
Other - Last Name:KIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-2828
Mailing Address - Country:US
Mailing Address - Phone:860-585-3906
Mailing Address - Fax:860-585-3907
Practice Address - Street 1:10 N MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-8122
Practice Address - Country:US
Practice Address - Phone:860-314-2052
Practice Address - Fax:860-314-2054
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0017541041C0700X
CT1754104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004196011Medicaid
CT004196011Medicaid