Healthcare Provider Details

I. General information

NPI: 1760543409
Provider Name (Legal Business Name): BRENDA BUTLER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WRAMC, BUILDING 6, DEPARTMENT OF SOCIAL WORK 6900 GEORGIA AVE. NW
WASHINGTON DC
20307-5001
US

IV. Provider business mailing address

2J38 WRAMC BLDG2 6900 GEORGIA AVE. NW
WASHINGTON DC
20307-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11960
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: