Provider Demographics
NPI:1235867011
Name:BOPP, CATHERINE ANN (CASAC 2)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:BOPP
Suffix:
Gender:F
Credentials:CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ISLE OF WIGHT RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-1309
Mailing Address - Country:US
Mailing Address - Phone:631-365-1274
Mailing Address - Fax:
Practice Address - Street 1:287 SPRINGS FIREPLACE RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-4823
Practice Address - Country:US
Practice Address - Phone:631-329-0373
Practice Address - Fax:718-210-3410
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32966101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)