Provider Demographics
NPI:1871792556
Name:BUTLER, BRUCE IRVIN (MSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:IRVIN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 16TH AVE
Mailing Address - Street 2:APT. 18
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1123
Mailing Address - Country:US
Mailing Address - Phone:229-395-8340
Mailing Address - Fax:
Practice Address - Street 1:613 16TH AVE
Practice Address - Street 2:APT. 18
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1123
Practice Address - Country:US
Practice Address - Phone:229-395-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0042181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical