Provider Demographics
NPI:1598321887
Name:BUTLER, CARL JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:BUTLER
Suffix:JR
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 1:3415 KEARSNEY ABBEY CIR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-6381
Mailing Address - Country:US
Mailing Address - Phone:813-766-2957
Mailing Address - Fax:
Practice Address - Street 1:710 OAKFIELD DR STE 210
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4924
Practice Address - Country:US
Practice Address - Phone:813-270-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW129381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical