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General NPI Number Information
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NPI Number | 1013873793
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Entity Type | Organization
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Legal Business Name | ORIGINAL THERAPY, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 12/26/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 333 E BROADWAY APT 506
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City | LONG BEACH
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State | CA
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Zip | 90802-6288
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Country | US
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Telephone | 213-798-4350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22
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City | LONG BEACH
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State | CA
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Zip | 90801-0022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | GABRAEL ROSENTHAL
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Credential | LCSW
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Telephone | 213-798-4350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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