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General NPI Number Information
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NPI Number | 1124859335
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Entity Type | Organization
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Legal Business Name | OPAL DBT, LLC
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 1171 LANCASTER AVE STE 100
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City | BERWYN
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State | PA
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Zip | 19312-2602
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Country | US
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Telephone | 484-674-6325
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Fax | 484-674-6325
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Provider Business Mailing Address
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Address Line | 1171 LANCASTER AVE STE 100
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City | BERWYN
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State | PA
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Zip | 19312-2602
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Country | US
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Telephone | 484-674-6324
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. NICOLE DANIELLA CHAIKIN
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Credential | PSYD
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Telephone | 484-674-6324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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