Provider Demographics
NPI:1104361575
Name:OPALKA, LENA
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:OPALKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16173 MARIPOSA CIR N
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4637
Mailing Address - Country:US
Mailing Address - Phone:954-646-2535
Mailing Address - Fax:
Practice Address - Street 1:50 TORCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2317
Practice Address - Country:US
Practice Address - Phone:954-290-3633
Practice Address - Fax:888-407-7512
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician