Healthcare Provider Details

I. General information

NPI: 1699856468
Provider Name (Legal Business Name): JOAN K BUTZEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16935 WEST BERNARDO DRIVE SUITE 145
SAN DIEGO CA
92127-1634
US

IV. Provider business mailing address

PO BOX 1089
POWAY CA
92074-1089
US

V. Phone/Fax

Practice location:
  • Phone: 858-485-7027
  • Fax: 858-485-7028
Mailing address:
  • Phone: 858-485-7027
  • Fax: 858-485-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS6665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: