MEDICARE: MATTHEW RYAN BUTTERY RBT

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	106S00000X	Behavior Technician	000256	VA

General Provider Information

NPI Number	:	1942970793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW RYAN BUTTERY RBT

Provider Business Mailing Address
First Line	:	2 VILLAGE SQ
Second Line	:	STE 210
City	:	BALTIMORE
State	:	MD
Zip	:	21210-1624
Country	:	US
Telephone Number	:	866-565-7222
Fax Number	:	877-734-1914

Provider Business Practice Location Address
First Line	:	6325 N CENTER DR STE 121
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-0012
Country	:	US
Telephone Number	:	866-565-7222
Fax Number	:	877-734-1914

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

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	01/23/2024

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