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NPI Code Detail

MEDICARE: BRIAN T BUTCH MDIV, MSW, MA, LCSW

MEDICARE:   BRIAN T BUTCH  MDIV, MSW, MA, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SC05319800NJ

General Provider Information

NPI Number : 1033657416
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN T BUTCH MDIV, MSW, MA, LCSW
Provider Business Mailing Address
First Line : 36 SOUTH ST
Second Line :
City : MANASQUAN
State : NJ
Zip : 08736-3440
Country : US
Telephone Number : 732-223-4673
Fax Number :
Provider Business Practice Location Address
First Line : 36 SOUTH ST
Second Line :
City : MANASQUAN
State : NJ
Zip : 08736-3440
Country : US
Telephone Number : 732-223-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2017
Last Update Date : 02/07/2017

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Directions to “ BRIAN T BUTCH MDIV, MSW, MA, LCSW” Practice Location

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