Provider Demographics
NPI:1376254714
Name:COPPOLA, SANDRA ELLEN (MS)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ELLEN
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 BOGERT RD
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2243
Mailing Address - Country:US
Mailing Address - Phone:201-805-5942
Mailing Address - Fax:
Practice Address - Street 1:669 BOGERT RD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2243
Practice Address - Country:US
Practice Address - Phone:201-805-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health