Provider Demographics
NPI:1033259809
Name:KOPPELMAN, ELISA ANN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:ANN
Last Name:KOPPELMAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PICKARD ST
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2710
Mailing Address - Country:US
Mailing Address - Phone:978-388-5211
Mailing Address - Fax:
Practice Address - Street 1:30 GENERAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1809
Practice Address - Country:US
Practice Address - Phone:978-620-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10273431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical