MEDICARE: MR. CHRISTOPHER ERIC BUTERBAUGH MED

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629135207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER ERIC BUTERBAUGH MED

Provider Business Mailing Address
First Line	:	105 HALFWAY POND ROAD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-3255
Country	:	US
Telephone Number	:	508-224-9469
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 INDUSTRIAL PARK ROAD
Second Line	:	SOUTH BAY MENTAL HEALTH CENTER
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-4868
Country	:	US
Telephone Number	:	508-830-0000
Fax Number	:	508-746-8429

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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