Provider Demographics
NPI:1093075137
Name:BUTTACAVOLI, ROSEMARY (TEACHER)
Entity type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:BUTTACAVOLI
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:MS
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:ESPINAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TEACHER
Mailing Address - Street 1:149 ROSEBUD CT
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4180
Mailing Address - Country:US
Mailing Address - Phone:516-473-7128
Mailing Address - Fax:
Practice Address - Street 1:149 ROSEBUD CT
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4180
Practice Address - Country:US
Practice Address - Phone:516-473-7128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY575136111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist