Provider Demographics
NPI:1144687476
Name:BUTLER, CORINNE (LSW)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W RED BANK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3407
Mailing Address - Country:US
Mailing Address - Phone:856-251-9059
Mailing Address - Fax:856-251-9324
Practice Address - Street 1:104 W RED BANK AVE
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3407
Practice Address - Country:US
Practice Address - Phone:856-251-9059
Practice Address - Fax:856-251-9324
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05735400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker