Provider Demographics
NPI:1194432153
Name:BUTLER, JASMINE KT (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:KT
Last Name:BUTLER
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 UTICA DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1622
Mailing Address - Country:US
Mailing Address - Phone:617-855-1954
Mailing Address - Fax:
Practice Address - Street 1:33 UTICA DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1622
Practice Address - Country:US
Practice Address - Phone:774-273-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician