Provider Demographics
NPI:1003186297
Name:COPELAND, RONALD EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:EDWARD
Last Name:COPELAND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 E STARBRIGHT CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-7046
Mailing Address - Country:US
Mailing Address - Phone:520-299-7636
Mailing Address - Fax:
Practice Address - Street 1:4653 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3437
Practice Address - Country:US
Practice Address - Phone:520-326-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-07441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical