=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225663206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILIE BUTLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2020
-----------------------------------------------------
Last Update Date | 12/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 KANE ST
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06119-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-848-0936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 KIRTLAND ST
-----------------------------------------------------
City | DEEP RIVER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06417-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 5206
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------