Provider Demographics
NPI:1033657416
Name:BUTCH, BRIAN T (MDIV, MSW, MA, LCSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:BUTCH
Suffix:
Gender:M
Credentials:MDIV, MSW, MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3440
Mailing Address - Country:US
Mailing Address - Phone:732-223-4673
Mailing Address - Fax:
Practice Address - Street 1:36 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3440
Practice Address - Country:US
Practice Address - Phone:732-223-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053198001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical