MEDICARE: MR. ROBERT O BUTLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS7338	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093718454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT O BUTLER LCSW

Provider Business Mailing Address
First Line	:	40 4TH ST
Second Line	:	STE. 224
City	:	PETALUMA
State	:	CA
Zip	:	94952-3040
Country	:	US
Telephone Number	:	707-241-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 4TH ST STE 224
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3040
Country	:	US
Telephone Number	:	707-241-3003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/11/2025

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