Provider Demographics
NPI:1669934337
Name:BONDAGE BREAKERS COUNSELING, LLC
Entity type:Organization
Organization Name:BONDAGE BREAKERS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNIC E
Authorized Official - Middle Name:V
Authorized Official - Last Name:MALACHI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-314-9551
Mailing Address - Street 1:PO BOX 6434
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-0434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79 TRUMBULL ST UNIT C9
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3708
Practice Address - Country:US
Practice Address - Phone:203-314-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty