Provider Demographics
NPI:1912364951
Name:BUTLER, RENEE ADELA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ADELA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 JAYWICK AVE
Mailing Address - Street 2:UNIT #513
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2021
Mailing Address - Country:US
Mailing Address - Phone:571-490-1421
Mailing Address - Fax:
Practice Address - Street 1:7200 JAYWICK AVE
Practice Address - Street 2:UNIT #513
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-2021
Practice Address - Country:US
Practice Address - Phone:571-490-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD205631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical