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General NPI Number Information
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NPI Number | 1669722831
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Entity Type | Organization
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Legal Business Name | ORANGE COUNTY PSYCHOTHERAPY ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 17821 E. 17TH ST. #260
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-730-7846
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Fax |
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Provider Business Mailing Address
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Address Line | 17821 E. 17TH ST. #260
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-730-7846
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, CFO
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Name | DR. CHERYL ANN FAROLE-ROMAN
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Credential | PSY.D., MFT
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Telephone | 714-730-7846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC36528
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License Number State | CA
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