Provider Demographics
NPI:1144361221
Name:BUTZEL, BRENDA S (MSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:BUTZEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1243
Mailing Address - Country:US
Mailing Address - Phone:212-831-4870
Mailing Address - Fax:212-831-4870
Practice Address - Street 1:109 E 36TH ST
Practice Address - Street 2:SUITE 5R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3447
Practice Address - Country:US
Practice Address - Phone:212-831-4870
Practice Address - Fax:212-831-4870
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0364441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9L221Medicare ID - Type Unspecified