Provider Demographics
NPI:1376590216
Name:COPELAND, NANCY JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JEAN
Last Name:COPELAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 S MOUNTAIN BLVD
Mailing Address - Street 2:STE C-2
Mailing Address - City:MOUNTAINTOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1984
Mailing Address - Country:US
Mailing Address - Phone:570-403-5080
Mailing Address - Fax:570-403-5079
Practice Address - Street 1:359 S MOUNTAIN BLVD
Practice Address - Street 2:STE C-2
Practice Address - City:MOUNTAINTOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1984
Practice Address - Country:US
Practice Address - Phone:570-403-5080
Practice Address - Fax:570-403-5079
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008628L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC0761126OtherBLUE CROSS SHIELD
2104527OtherCIGNA
2104527OtherCIGNA