Healthcare Provider Details

I. General information

NPI: 1770943599
Provider Name (Legal Business Name): KENNETH BUTLER JR. LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HUNT ST
WOODSTOWN NJ
08098-1127
US

IV. Provider business mailing address

29 HUNT ST
WOODSTOWN NJ
08098-1127
US

V. Phone/Fax

Practice location:
  • Phone: 856-434-2887
  • Fax:
Mailing address:
  • Phone: 856-434-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37F100248500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: