Provider Demographics
NPI:1427620020
Name:BRODHECKER, DANA (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BRODHECKER
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VILLAGE WAY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3111
Mailing Address - Country:US
Mailing Address - Phone:845-800-5931
Mailing Address - Fax:
Practice Address - Street 1:175 KINDERKAMACK RD # 1042
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1335
Practice Address - Country:US
Practice Address - Phone:201-500-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01014900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health