MEDICARE: MR. MATTHEW A BUTLER LISW-S, LICDC

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	I.1200574	OH

General Provider Information

NPI Number	:	1477814796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW A BUTLER LISW-S, LICDC

Provider Business Mailing Address
First Line	:	1227 WESTSHORE DR
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-2329
Country	:	US
Telephone Number	:	440-276-0914
Fax Number	:	440-299-6408

Provider Business Practice Location Address
First Line	:	1227 WESTSHORE DR
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-2329
Country	:	US
Telephone Number	:	440-276-0914
Fax Number	:	440-299-6408

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

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	01/19/2023

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