Provider Demographics
NPI:1154897213
Name:BUTLER, PATRICK (MS)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 BARRIE AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1704
Mailing Address - Country:US
Mailing Address - Phone:516-592-7668
Mailing Address - Fax:
Practice Address - Street 1:1032 BARRIE AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1704
Practice Address - Country:US
Practice Address - Phone:516-592-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1257688181103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool