Healthcare Provider Details

I. General information

NPI: 1225575632
Provider Name (Legal Business Name): BREAKTHROUGH SOLUTIONS WORLDWIDE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DEAN ST STE 347
BROOKLYN NY
11238-3381
US

IV. Provider business mailing address

1657 NOSTRAND AVE APT 3R
BROOKLYN NY
11226-5579
US

V. Phone/Fax

Practice location:
  • Phone: 646-475-2776
  • Fax:
Mailing address:
  • Phone: 646-258-4394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007159
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number007159
License Number StateNY

VIII. Authorized Official

Name: MR. LAWRENCE LOVELL
Title or Position: FOUNDER
Credential:
Phone: 646-258-4394