Healthcare Provider Details

I. General information

NPI: 1073888335
Provider Name (Legal Business Name): OPTIMAL BEGINNINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 RIVER RD SUITE 300
BETHESDA MD
20816-1405
US

IV. Provider business mailing address

5272 RIVER RD SUITE 300
BETHESDA MD
20816-1405
US

V. Phone/Fax

Practice location:
  • Phone: 301-718-1716
  • Fax: 301-718-1766
Mailing address:
  • Phone: 301-718-1716
  • Fax: 301-718-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17943
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-06-3014
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-10359
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8018
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1107456
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1096383
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11314065
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0145875
License Number StateMD
# 9
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0146026
License Number StateMD
# 10
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1062969
License Number StateNY
# 11
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1073745
License Number StateMD

VIII. Authorized Official

Name: MS. DANA VISALLI-GOLD
Title or Position: EXECUTIVE DIRECTOR & CEO
Credential: BCBA-D, PH.D
Phone: 301-718-1716