Provider Demographics
NPI:1063456945
Name:COPEN, JULIA ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ROSE
Last Name:COPEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504
Mailing Address - Country:US
Mailing Address - Phone:814-824-6202
Mailing Address - Fax:
Practice Address - Street 1:1910 SASSAFRAS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502
Practice Address - Country:US
Practice Address - Phone:814-452-5843
Practice Address - Fax:814-452-7610
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006800L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118844Medicare ID - Type Unspecified