Provider Demographics
NPI:1316791486
Name:BUTTERWORTH, LORRAINE KAY (MED, MA, PSYD ASSOC)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:KAY
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:MED, MA, PSYD ASSOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 SOQUEL DR STE 10
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-3101
Mailing Address - Country:US
Mailing Address - Phone:831-239-2015
Mailing Address - Fax:
Practice Address - Street 1:4630 SOQUEL DR STE 10
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-3101
Practice Address - Country:US
Practice Address - Phone:831-239-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94028212103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent