Provider Demographics
NPI:1124859335
Name:OPAL DBT, LLC
Entity type:Organization
Organization Name:OPAL DBT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DANIELLA
Authorized Official - Last Name:CHAIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:484-674-6324
Mailing Address - Street 1:1171 LANCASTER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-2602
Mailing Address - Country:US
Mailing Address - Phone:484-674-6324
Mailing Address - Fax:
Practice Address - Street 1:1171 LANCASTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-2602
Practice Address - Country:US
Practice Address - Phone:484-674-6325
Practice Address - Fax:484-674-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty