Provider Demographics
NPI:1366027526
Name:GROSICKA-KOPTYRA, MONIKA (MA LBSC)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:GROSICKA-KOPTYRA
Suffix:
Gender:F
Credentials:MA LBSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1925
Mailing Address - Country:US
Mailing Address - Phone:267-886-0648
Mailing Address - Fax:
Practice Address - Street 1:26 SUMMIT GROVE AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3230
Practice Address - Country:US
Practice Address - Phone:267-886-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003110101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor