Provider Demographics
NPI:1548316839
Name:BUTNIK, STEVEN MARK (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:BUTNIK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3400
Mailing Address - Country:US
Mailing Address - Phone:804-282-9989
Mailing Address - Fax:804-282-9930
Practice Address - Street 1:6722 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3400
Practice Address - Country:US
Practice Address - Phone:804-282-9989
Practice Address - Fax:804-282-9930
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7712316Medicaid
VA7712316Medicaid