Provider Demographics
NPI:1255902391
Name:BREDA, BILLIE AVERY IRIS (LCSW)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:AVERY IRIS
Last Name:BREDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WOODPORT RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2641
Mailing Address - Country:US
Mailing Address - Phone:973-862-6066
Mailing Address - Fax:973-862-6048
Practice Address - Street 1:191 WOODPORT RD STE 206
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2641
Practice Address - Country:US
Practice Address - Phone:973-862-6066
Practice Address - Fax:973-862-6048
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06378500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker