Provider Demographics
NPI:1558422113
Name:ZELCH BUTAN, LYNNE B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:B
Last Name:ZELCH BUTAN
Suffix:
Gender:F
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:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-0615
Mailing Address - Country:US
Mailing Address - Phone:609-529-3480
Mailing Address - Fax:
Practice Address - Street 1:89 PRINCETON ARMS S # 1
Practice Address - Street 2:BUILDING 5
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08512-1206
Practice Address - Country:US
Practice Address - Phone:609-529-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001705001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086308TKYMedicare ID - Type Unspecified