MEDICARE: ORIGINAL THERAPY, A LICENSED CLINICAL SOCIAL WORKER CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1013873793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORIGINAL THERAPY, A LICENSED CLINICAL SOCIAL WORKER CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 22
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90801-0022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 E BROADWAY APT 506
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-6288
Country	:	US
Telephone Number	:	213-798-4350
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	GABRAEL ROSENTHAL
Credential	:	LCSW
Telephone Number	:	213-798-4350

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/29/2025

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