Provider Demographics
NPI:1699856468
Name:BUTZEN, JOAN K (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:K
Last Name:BUTZEN
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 1089
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92074-1089
Mailing Address - Country:US
Mailing Address - Phone:858-485-7027
Mailing Address - Fax:858-485-7028
Practice Address - Street 1:16935 WEST BERNARDO DRIVE
Practice Address - Street 2:SUITE 145
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1634
Practice Address - Country:US
Practice Address - Phone:858-485-7027
Practice Address - Fax:858-485-7028
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS66651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical