Organization Name: | MINDY S KOPOLOW PSYD PA |
NPI Number: | 1073633327 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MINDY SUE KOPOLOW (PRESIDENT) |
Mailing Address: | 400 W Cummings Park Suite 3400 Woburn |
State: | MA US |
Postal Code: | 018016519 |
Phone Number: | 6179725055 |
Fax Number: | 6179725011 |
NPI Enumeration Date: | 03/30/2007 |
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: |