Provider Demographics
NPI:1356429799
Name:BUTTO, ANTHONY GENE (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GENE
Last Name:BUTTO
Suffix:
Gender:M
Credentials:DSW, LCSW
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1372 N SUSQUEHANNA TRL
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-7768
Mailing Address - Country:US
Mailing Address - Phone:570-743-2323
Mailing Address - Fax:570-743-2343
Practice Address - Street 1:1372 N SUSQUEHANNA TRL
Practice Address - Street 2:SUITE 330
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-7768
Practice Address - Country:US
Practice Address - Phone:570-743-2323
Practice Address - Fax:570-743-2343
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0120871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA651528Medicare ID - Type UnspecifiedMEDICARE NUMBER