Provider Demographics
NPI:1316445810
Name:DWEH, BUSTER KLAY
Entity type:Individual
Prefix:
First Name:BUSTER
Middle Name:KLAY
Last Name:DWEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ELM ST APT AP1
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-2549
Mailing Address - Country:US
Mailing Address - Phone:609-372-8199
Mailing Address - Fax:
Practice Address - Street 1:141 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2925
Practice Address - Country:US
Practice Address - Phone:609-324-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health