Healthcare Provider Details

I. General information

NPI: 1730024548
Provider Name (Legal Business Name): VINCENZA BUTERA LMSW CLINICAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3601
US

IV. Provider business mailing address

173 IRONWOOD DRIVE
AMHERSTBURG ONTARIO
N9V3V3
CA

V. Phone/Fax

Practice location:
  • Phone: 519-819-7949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119952
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: