Provider Demographics
NPI:1356525927
Name:BUTLER-JONES, CORA (LICSW)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:BUTLER-JONES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STOCKHOLM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1530
Mailing Address - Country:US
Mailing Address - Phone:508-873-0277
Mailing Address - Fax:508-797-5618
Practice Address - Street 1:370 MAIN ST STE 910
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1723
Practice Address - Country:US
Practice Address - Phone:508-873-0277
Practice Address - Fax:508-797-5618
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1142121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000388401Medicare PIN