MEDICARE: KIMBERLY WILSON BUTLER LMSW

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	104100000X	Social Worker	073813	NY

General Provider Information

NPI Number	:	1407980162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY WILSON BUTLER LMSW

Provider Business Mailing Address
First Line	:	4600 MILLENNIUM DR
Second Line	:
City	:	GENESEO
State	:	NY
Zip	:	14454-1197
Country	:	US
Telephone Number	:	585-243-7250
Fax Number	:	585-243-7264

Provider Business Practice Location Address
First Line	:	4600 MILLENNIUM DR
Second Line	:
City	:	GENESEO
State	:	NY
Zip	:	14454-1197
Country	:	US
Telephone Number	:	585-243-7250
Fax Number	:	585-243-7264

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/31/2009

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