=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447315395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREAKING THE CHAIN COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 07/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 295 MAIN ST 2 FL
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07928-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-298-0301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 651 MONMOUTH AVE
-----------------------------------------------------
City | PORT MONMOUTH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07758-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-298-0301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DANIEL P PITZER
-----------------------------------------------------
Credential | LCSW, LCADC
-----------------------------------------------------
Telephone | 732-298-0301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05185600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05185500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------