Provider Demographics
NPI:1306970736
Name:BUTLER, KRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W KENNEDY BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2952
Mailing Address - Country:US
Mailing Address - Phone:813-689-0139
Mailing Address - Fax:
Practice Address - Street 1:509 WILBUR ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5323
Practice Address - Country:US
Practice Address - Phone:813-689-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW65231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical