Healthcare Provider Details

I. General information

NPI: 1992288591
Provider Name (Legal Business Name): MATTHEW BUTLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MIDWAY AVE
LANSDOWNE PA
19050-1421
US

IV. Provider business mailing address

180 MIDWAY AVE
LANSDOWNE PA
19050-1421
US

V. Phone/Fax

Practice location:
  • Phone: 484-350-9919
  • Fax:
Mailing address:
  • Phone: 484-350-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW028069
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: