Active NPI
Ian Buterbaugh, LCSW-C
- Clinical Social Worker
- Frederick, MD
National Provider Identifier
1679082424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 24757
- Practice address
- 1434 Porter St
Frederick, MD 21702-9254 - Phone
- (301) 619-8096
- NPI assigned
- Sep 25, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CW021182 | PA | |
| Clinical Social Worker | 1041C0700X | 24757 | MD | Primary |
Addresses
Primary practice location
1434 Porter St
Frederick, MD 21702-9254
Mailing address
700 Glen Allen Dr
Baltimore, MD 21229-1422
Phone (717) 455-0377
Other practice location 1
700 Glen Allen Dr
Baltimore, MD 21229-1422
Phone (717) 455-0377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24757 | MD | MD | Clinical Social Worker |
| CW021182 | PA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dochas Counseling, LLC | Clinical | Current | Accepting new patients |
| Blackbird Clinical Services PC | Past | Accepting new patients | |
| Children's Integrated Center for Success | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Baltimore, MD
- NPI 1770210890
-
- Child & Adolescent Psychiatry Physician
- Allentown, PA
- NPI 1598524563
-
- Family Nurse Practitioner
- Allentown, PA
- NPI 1447670708
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732579200000",
"number": "1679082424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 GLEN ALLEN DR",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212291422",
"telephone_number": "717-455-0377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1434 PORTER ST",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217029254",
"telephone_number": "301-619-8096"
}
],
"practiceLocations": [
{
"address_1": "700 Glen Allen Dr",
"address_purpose": "LOCATION",
"city": "Baltimore",
"state": "MD",
"postal_code": "212291422",
"country_code": "US",
"telephone_number": "717-455-0377",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUTERBAUGH",
"first_name": "IAN",
"credential": "LCSW-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-09-25",
"last_updated": "2024-11-26",
"certification_date": "2024-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": "CW021182",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "24757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.