Provider Demographics
NPI:1093818015
Name:COPELAND, MARJORIE ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANNE
Last Name:COPELAND
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 1:120 HEARTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9550
Mailing Address - Country:US
Mailing Address - Phone:856-336-2187
Mailing Address - Fax:
Practice Address - Street 1:95 ROUTE 73
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9532
Practice Address - Country:US
Practice Address - Phone:856-906-0782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC019291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
223652341OtherEIN
223652341OtherEIN