Healthcare Provider Details

I. General information

NPI: 1265812895
Provider Name (Legal Business Name): OPTIMAL BEGINNINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 05/02/2016
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 Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMD

VIII. Authorized Official

Name: DANA VISALLI-GOLD
Title or Position: OWNER/CEO
Credential:
Phone: 301-718-1716