Provider Demographics
NPI:1124253349
Name:BUTLER, LORI LEE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:LEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:140-15B SANFORD AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-358-8288
Mailing Address - Fax:718-358-5265
Practice Address - Street 1:14015B SANFORD AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2557
Practice Address - Country:US
Practice Address - Phone:718-358-8288
Practice Address - Fax:718-358-5265
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health