Provider Demographics
NPI:1366333841
Name:BREAKAWAY CHILD AND FAMILY THERAPY, PC
Entity type:Organization
Organization Name:BREAKAWAY CHILD AND FAMILY THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:VENYEI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:510-384-1778
Mailing Address - Street 1:177 BUTCHER RD STE A
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5695
Mailing Address - Country:US
Mailing Address - Phone:510-384-1778
Mailing Address - Fax:
Practice Address - Street 1:177 BUTCHER RD STE A
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5695
Practice Address - Country:US
Practice Address - Phone:510-384-1778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREAKAWAY CHILD AND FAMILY THERAPY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty