Healthcare Provider Details

I. General information

NPI: 1790572824
Provider Name (Legal Business Name): DANIELLE M BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 BONITA AVE
BERKELEY CA
94709-1909
US

IV. Provider business mailing address

1919 ADDISON ST STE 204
BERKELEY CA
94704-1143
US

V. Phone/Fax

Practice location:
  • Phone: 510-526-4765
  • Fax:
Mailing address:
  • Phone: 510-899-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: