Provider Demographics
NPI:1083055354
Name:POPMA, JOELLEN (PHD)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:POPMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270356
Mailing Address - Street 2:738 LIBRARY ROAD
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14627-0356
Mailing Address - Country:US
Mailing Address - Phone:585-275-3113
Mailing Address - Fax:585-442-0815
Practice Address - Street 1:165 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3031
Practice Address - Country:US
Practice Address - Phone:412-999-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8252726103TC1900X
PAPS-008741-L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling