Healthcare Provider Details

I. General information

NPI: 1699454173
Provider Name (Legal Business Name): EWA ELZBIETA OPALA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 72ND ST APT 134
BROOKLYN NY
11209-2072
US

IV. Provider business mailing address

190 72ND ST APT 134
BROOKLYN NY
11209-2072
US

V. Phone/Fax

Practice location:
  • Phone: 347-620-2080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: