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General NPI Number Information
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NPI Number | 1225427990
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Entity Type | Organization
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Legal Business Name | BREAKING DAWN COUNSELING, ROSEANNA BODNER, LCSW L.L.C.
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Dates
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Enumeration Date | 01/17/2015
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Last Update Date | 01/17/2015
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Provider Practice Location Address
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Address Line | 571 ROUTE 168
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-1458
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Country | US
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Telephone | 856-534-3183
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Fax |
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Provider Business Mailing Address
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Address Line | 1035 BAYWOOD DR
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-2807
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Country | US
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Telephone | 856-534-3183
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROSEANNA BODNER
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Credential | LCSW
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Telephone | 856-534-3183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05272400
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License Number State | NJ
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