Provider Demographics
NPI:1508956871
Name:FROBERG, BUTCH LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BUTCH
Middle Name:LAWRENCE
Last Name:FROBERG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1445
Mailing Address - Country:US
Mailing Address - Phone:714-227-5560
Mailing Address - Fax:
Practice Address - Street 1:1665 SCENIC AVE
Practice Address - Street 2:STE. 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1445
Practice Address - Country:US
Practice Address - Phone:714-227-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical