MEDICARE: MR. PETER JAMES 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	006563	CT

General Provider Information

NPI Number	:	1487252995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER JAMES BUTLER LCSW

Provider Business Mailing Address
First Line	:	665 TOWNSEND AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06512-3124
Country	:	US
Telephone Number	:	203-641-4472
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 DIXWELL AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-1744
Country	:	US
Telephone Number	:	203-772-1092
Fax Number	:

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

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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