Provider Demographics
NPI:1306357058
Name:COPPA, AMY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COPPA
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 1:610 SE 46TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97366-1039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 SE 46TH ST APT 4
Practice Address - Street 2:
Practice Address - City:SOUTH BEACH
Practice Address - State:OR
Practice Address - Zip Code:97366-1039
Practice Address - Country:US
Practice Address - Phone:541-351-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-21
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0161991041C0700X
ORL83241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical