Healthcare Provider Details

I. General information

NPI: 1952943581
Provider Name (Legal Business Name): MS. JE'LEAH J BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 PARKWAY AVE STE A1
EWING NJ
08618-2704
US

IV. Provider business mailing address

11 SHERMAN PL
LAWRENCE NJ
08648-4341
US

V. Phone/Fax

Practice location:
  • Phone: 732-983-2555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05663700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: