MEDICARE: ELIZABETH H BUTLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS6481	CA

General Provider Information

NPI Number	:	1235263310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH H BUTLER LCSW

Provider Business Mailing Address
First Line	:	110 W PENNSYLVANIA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4016
Country	:	US
Telephone Number	:	619-298-0224
Fax Number	:	619-440-8380

Provider Business Practice Location Address
First Line	:	110 W PENNSYLVANIA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4016
Country	:	US
Telephone Number	:	619-298-0224
Fax Number	:	619-440-8380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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