Provider Demographics
NPI:1063633261
Name:BUTOW, JENNIFER KELLY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KELLY
Last Name:BUTOW
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:709 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2515
Mailing Address - Country:US
Mailing Address - Phone:732-892-8709
Mailing Address - Fax:732-714-0924
Practice Address - Street 1:71 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2138
Practice Address - Country:US
Practice Address - Phone:732-294-7870
Practice Address - Fax:732-714-0924
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008455001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical