Provider Demographics
NPI:1104486554
Name:BUTT, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ORCHARD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03086-5733
Mailing Address - Country:US
Mailing Address - Phone:603-654-1008
Mailing Address - Fax:
Practice Address - Street 1:30 ORCHARD VIEW DR
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:NH
Practice Address - Zip Code:03086-5733
Practice Address - Country:US
Practice Address - Phone:603-654-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician