Provider Demographics
NPI:1356199392
Name:BUTLER, KYRIEL (LMSW)
Entity type:Individual
Prefix:
First Name:KYRIEL
Middle Name:
Last Name:BUTLER
Suffix:
Gender:X
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 MADISON ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3859
Mailing Address - Country:US
Mailing Address - Phone:541-647-7981
Mailing Address - Fax:
Practice Address - Street 1:1856 MADISON ST APT 1L
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3859
Practice Address - Country:US
Practice Address - Phone:541-647-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117196104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker