Provider Demographics
NPI:1902477466
Name:BUTTERWORTH, MANA DANIELA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MANA
Middle Name:DANIELA
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:MANA
Other - Middle Name:D
Other - Last Name:BUTTERWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:1185 S REDONDO CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-2036
Practice Address - Country:US
Practice Address - Phone:928-414-7037
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AZBEH-001642103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-22-61495OtherBCBA CERTIFICATE