Provider Demographics
NPI:1225427990
Name:BREAKING DAWN COUNSELING, ROSEANNA BODNER, LCSW L.L.C.
Entity Type:Organization
Organization Name:BREAKING DAWN COUNSELING, ROSEANNA BODNER, LCSW L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BODNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-534-3183
Mailing Address - Street 1:1035 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-2807
Mailing Address - Country:US
Mailing Address - Phone:856-534-3183
Mailing Address - Fax:
Practice Address - Street 1:571 ROUTE 168
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1458
Practice Address - Country:US
Practice Address - Phone:856-534-3183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052724001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty