Provider Demographics
NPI:1073749065
Name:COPPOLA, CONSTANTINA (MS)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANTINA
Middle Name:
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2318
Mailing Address - Country:US
Mailing Address - Phone:718-309-2106
Mailing Address - Fax:
Practice Address - Street 1:25 KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2318
Practice Address - Country:US
Practice Address - Phone:718-309-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst