Provider Demographics
NPI:1750402160
Name:BUTLER, ADRIENNE J (EDD)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4203
Mailing Address - Country:US
Mailing Address - Phone:207-866-2143
Mailing Address - Fax:
Practice Address - Street 1:20 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-4203
Practice Address - Country:US
Practice Address - Phone:207-866-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS318103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist