Healthcare Provider Details

I. General information

NPI: 1427106004
Provider Name (Legal Business Name): AMY A BRESLOW MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E. MARLTON PIKE STE N-70
CHERRY HILL NJ
08003-2150
US

IV. Provider business mailing address

1930 E. MARLTON PIKE STE N-70
CHERRY HILL NJ
08003-2150
US

V. Phone/Fax

Practice location:
  • Phone: 856-985-6300
  • Fax: 856-985-6424
Mailing address:
  • Phone: 856-985-6300
  • Fax: 856-985-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04407500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: