MEDICARE: MS. JENNIFER AYANNA BUTLER J.D., M.S.W.

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

General Provider Information

NPI Number	:	1912217076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER AYANNA BUTLER J.D., M.S.W.

Provider Business Mailing Address
First Line	:	21 TEMPLE ST
Second Line	:	APARTMENT 807
City	:	HARTFORD
State	:	CT
Zip	:	06103-1310
Country	:	US
Telephone Number	:	860-402-8428
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 TEMPLE ST
Second Line	:	APARTMENT 807
City	:	HARTFORD
State	:	CT
Zip	:	06103-1310
Country	:	US
Telephone Number	:	860-402-8428
Fax Number	:

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

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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