Provider Demographics
NPI:1992259634
Name:BUTKA, TIMOTHY R (LCSW-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:BUTKA
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 CHELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2608
Mailing Address - Country:US
Mailing Address - Phone:571-213-2396
Mailing Address - Fax:
Practice Address - Street 1:6602 CHELWOOD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2608
Practice Address - Country:US
Practice Address - Phone:571-213-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2024-10-21
Deactivation Date:2018-02-14
Deactivation Code:
Reactivation Date:2024-10-21
Provider Licenses
StateLicense IDTaxonomies
MD271761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical