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General NPI Number Information
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NPI Number | 1629383120
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 301 SOUTH LIVINGSTON AVENUE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3932
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Country | US
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Telephone | 973-857-5121
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Fax |
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Provider Business Mailing Address
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Address Line | 16 BRENTWOOD DRIVE
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City | VERONA
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State | NJ
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Zip | 07044-2519
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE PROVIDER
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Name | ANNETTE M VACCARO
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Credential | LCSW
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Telephone | 973-857-5121
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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 | 44SC05162000
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License Number State | NJ
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