MEDICARE: VITAL PAUSE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1407743966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL PAUSE LLC

Provider Business Mailing Address
First Line	:	2600 TILTON RD UNIT 5277
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-1831
Country	:	US
Telephone Number	:	609-380-3007
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 TILTON RD UNIT 5277
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-1831
Country	:	US
Telephone Number	:	609-380-3007
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/OWNER
Name	:	SONY MARIE RODRIGUEZ
Credential	:	LCSW
Telephone Number	:	609-380-3007

Provider Enumeration Date	:	06/18/2025
Last Update Date	:	06/18/2025

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Directions to “VITAL PAUSE LLC ” Practice Location

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