| Doctor Name: | DR. MINDY SUE KOPOLOW |
| NPI Number: | 1053583120 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., PSY.D. |
| License Number: | 851 |
| Business Practice Address: | 400 W Cummings Park Suite 3400 Woburn, MA - 018016519 |
| Business Phone Number: | 6179725055 |
| Business Fax Number: | 6179725011 |
| Mailing Address: | 400 W Cummings Park, Suite 3400 WOBURN |
| State: | MA |
| Postal Code: | 018016519 |
| Phone Number: | 6179725055 |
| Fax Number: | 6179725011 |
| NPI Enumeration Date: | 03/29/2008 |
| NPI Last Update Date: | 04/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 851 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |