Provider Demographics
NPI:1003294596
Name:COPPOLA, JOHN (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WARREN ST
Mailing Address - Street 2:STE WSFCA
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4049
Mailing Address - Country:US
Mailing Address - Phone:603-226-1999
Mailing Address - Fax:
Practice Address - Street 1:33 WARREN ST
Practice Address - Street 2:STE WSFCA
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4049
Practice Address - Country:US
Practice Address - Phone:603-226-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist