Provider Demographics
NPI:1306641048
Name:BUTNIK, SUELLEN
Entity type:Individual
Prefix:MRS
First Name:SUELLEN
Middle Name:
Last Name:BUTNIK
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 1:257 15TH ST STE 203-2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4988
Mailing Address - Country:US
Mailing Address - Phone:917-946-1957
Mailing Address - Fax:
Practice Address - Street 1:257 15TH ST STE 203-2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4988
Practice Address - Country:US
Practice Address - Phone:917-946-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP132616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health