Provider Demographics
NPI:1346571668
Name:PITZER, MICHELE H (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:H
Last Name:PITZER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 MONMOUTH AVE
Mailing Address - Street 2:BREAKING THE CHAIN COUNSELING, LLC
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1517
Mailing Address - Country:US
Mailing Address - Phone:732-450-0533
Mailing Address - Fax:732-787-5717
Practice Address - Street 1:10 FAIRMOUNT AVE
Practice Address - Street 2:BREAKING THE CHAIN COUNSELING, LLC
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2343
Practice Address - Country:US
Practice Address - Phone:732-450-0533
Practice Address - Fax:732-787-5717
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051855001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ179291OtherMEDICARE PTAN