Provider Demographics
NPI:1730816059
Name:BUTLER, BROOKE KATHRYN (LBS)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:KATHRYN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 NAZARETH PIKE
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064
Mailing Address - Country:US
Mailing Address - Phone:610-365-8373
Mailing Address - Fax:
Practice Address - Street 1:224 NAZARETH PIKE
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064
Practice Address - Country:US
Practice Address - Phone:610-365-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health