1063633261 NPI number — JENNIFER KELLY BUTOW MSW, LCSW

Table of content: JENNIFER KELLY BUTOW MSW, LCSW (NPI 1063633261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063633261 NPI number — JENNIFER KELLY BUTOW MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTOW
Provider First Name:
JENNIFER
Provider Middle Name:
KELLY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUNT
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
K.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.W., L.C.S.W.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063633261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 GROVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POINT PLEASANT BEACH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08742-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-892-8709
Provider Business Mailing Address Fax Number:
732-714-0924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-294-7870
Provider Business Practice Location Address Fax Number:
732-714-0924
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC00845500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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