Breath of Life Counseling Services, LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

37LC00162000 Issued in NJ

Legal business name

BREATH OF LIFE COUNSELING SERVICES, LLC

Practice address

107 Cedar Grove LN Ste 103E
Somerset, NJ 08873-4719

Phone

(732) 690-4616

Fax

(732) 805-0303

NPI assigned

Jul 28, 2013

Last updated

Jul 28, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Edgardo Lionel Fernandez, LCADCNPI 1508614868

Title

Director

Phone

(732) 690-4616

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Edgardo Fernandez, LCADC

  • Addiction (Substance Use Disorder) Counselor
  • Somerset, NJ
  • NPI 1508614868
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374969600000",
    "number": "1841632155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 CEDAR GROVE LN STE 103E",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088734719",
            "telephone_number": "732-690-4616",
            "fax_number": "732-805-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 CEDAR GROVE LN STE 103E",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088734719",
            "telephone_number": "732-690-4616",
            "fax_number": "732-805-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREATH OF LIFE COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-28",
        "last_updated": "2013-07-28",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "EDGARDO",
        "authorized_official_middle_name": "LIONEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "732-690-4616",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCADC"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NJ",
            "license": "37LC00162000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Somerset, NJ
• Providers in Somerset, NJ by specialty
• Early Intervention Provider Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.