Provider Demographics
NPI:1770184459
Name:OPUS THERAPY LCSW, PC
Entity Type:Organization
Organization Name:OPUS THERAPY LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SOLE SHARE HOLDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNAHUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-837-9194
Mailing Address - Street 1:3515 75TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4427
Mailing Address - Country:US
Mailing Address - Phone:917-837-9194
Mailing Address - Fax:
Practice Address - Street 1:3515 75TH ST APT 208
Practice Address - Street 2:
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4427
Practice Address - Country:US
Practice Address - Phone:917-837-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty