Provider Demographics
NPI:1104949106
Name:KITAZAWA-BUTTE, MEGU (MA, ATR-BC, LCAT)
Entity type:Individual
Prefix:MS
First Name:MEGU
Middle Name:
Last Name:KITAZAWA-BUTTE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 SKILLMAN AVE
Mailing Address - Street 2:4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2405
Mailing Address - Country:US
Mailing Address - Phone:917-326-0856
Mailing Address - Fax:
Practice Address - Street 1:2020 BROADWAY
Practice Address - Street 2:3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5008
Practice Address - Country:US
Practice Address - Phone:917-326-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000323-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist