MEDICARE: NEW DAWN COUNSELING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	LA74183B	FL

General Provider Information

NPI Number	:	1225194400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW DAWN COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	736 MOUNTAIN BLVD
Second Line	:	2ND FLOOR
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6243
Country	:	US
Telephone Number	:	732-469-9996
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 SMOKE RISE DR
Second Line	:
City	:	WARREN
State	:	NJ
Zip	:	07059-6821
Country	:	US
Telephone Number	:	732-469-3371
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PASTORAL COUNSELO
Name	:	DR. DAWN J LACOSTA
Credential	:	D.M.DIV.
Telephone Number	:	732-469-9996

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/22/2020

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