Healthcare Provider Details

I. General information

NPI: 1396572939
Provider Name (Legal Business Name): OPALITE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 LARCH ST APT B
ALHAMBRA CA
91801-6509
US

IV. Provider business mailing address

2232 LARCH ST APT B
ALHAMBRA CA
91801-6509
US

V. Phone/Fax

Practice location:
  • Phone: 818-861-9242
  • Fax:
Mailing address:
  • Phone: 323-804-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE CHERRY
Title or Position: OWNER
Credential: LCSW
Phone: 818-861-9242