Provider Demographics
NPI:1861752974
Name:BUTERO, MARYLOU M (MSW)
Entity type:Individual
Prefix:MS
First Name:MARYLOU
Middle Name:M
Last Name:BUTERO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EIGHTH GREEN DR
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-5214
Mailing Address - Country:US
Mailing Address - Phone:774-451-5597
Mailing Address - Fax:
Practice Address - Street 1:15 EIGHTH GREEN DR
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-5214
Practice Address - Country:US
Practice Address - Phone:774-451-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA376101YA0400X
MA10175431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)