Provider Demographics
NPI:1457382632
Name:BUTLER, DEBORAH A (MSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
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 1:1 JOSLIN PL
Mailing Address - Street 2:ROOM 360
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5306
Mailing Address - Country:US
Mailing Address - Phone:617-732-2699
Mailing Address - Fax:617-732-2451
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:ROOM 360
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-732-2699
Practice Address - Fax:617-732-2451
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1108291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1852035Medicaid
MABUP22/918Medicare ID - Type Unspecified