Provider Demographics
NPI:1942540992
Name:MAXINE W BUTLER LCSW LLC
Entity Type:Organization
Organization Name:MAXINE W BUTLER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-751-0194
Mailing Address - Street 1:1916 MARLTON PIKE E
Mailing Address - Street 2:SUITE TWO
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2139
Mailing Address - Country:US
Mailing Address - Phone:856-751-0194
Mailing Address - Fax:856-751-6201
Practice Address - Street 1:1916 MARLTON PIKE E
Practice Address - Street 2:SUITE TWO
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2139
Practice Address - Country:US
Practice Address - Phone:856-751-0194
Practice Address - Fax:856-751-6201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXINE W BUTLER LCSW LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001389001041C0700X
NJ37F100122700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ604054Medicare PIN