Provider Demographics
NPI:1336635176
Name:COPELAND, REAGAN E (LCSW)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:E
Last Name:COPELAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:E
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2834 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3502
Mailing Address - Country:US
Mailing Address - Phone:610-248-1697
Mailing Address - Fax:
Practice Address - Street 1:1200 W TABOR RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3019
Practice Address - Country:US
Practice Address - Phone:267-456-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0216971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical