Healthcare Provider Details

I. General information

NPI: 1295710374
Provider Name (Legal Business Name): DOREEN E BUTTNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOREEN E KIPP

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST SUITE 210
BRISTOL CT
06010-8122
US

IV. Provider business mailing address

PO BOX 2828
BRISTOL CT
06011-2828
US

V. Phone/Fax

Practice location:
  • Phone: 860-314-2052
  • Fax: 860-314-2054
Mailing address:
  • Phone: 860-585-3906
  • Fax: 860-585-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1754
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001754
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: