Provider Demographics
NPI:1528166873
Name:BUTLER, JOCELYN J (MSW LCSW)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1547
Mailing Address - Country:US
Mailing Address - Phone:260-436-5353
Mailing Address - Fax:260-436-5399
Practice Address - Street 1:6335 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1547
Practice Address - Country:US
Practice Address - Phone:260-436-5353
Practice Address - Fax:260-436-5399
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340008791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN028606OtherVALUE OPTIONS PROVIDER
IN090721OtherMANAGED HEALTH NETWORK
IN000000374537OtherANTHEM PROVIDER NUMBER
IN059800000OtherMAGELLAN PROVIDER NUMBER
IN090721OtherMANAGED HEALTH NETWORK