Provider Demographics
NPI:1417954678
Name:KOPREVICH, MARY ERIN (CRC, LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ERIN
Last Name:KOPREVICH
Suffix:
Gender:F
Credentials:CRC, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2108
Mailing Address - Country:US
Mailing Address - Phone:716-573-7026
Mailing Address - Fax:716-773-5642
Practice Address - Street 1:2680 GRAND ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1693
Practice Address - Country:US
Practice Address - Phone:716-573-7026
Practice Address - Fax:716-773-5642
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0580061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY213352471OtherUNITED BEHAVIORAL HEALTH
NY6213037OtherINDEPENDENT HEALTH
NY000 2731 6601OtherUNIVERA
NY02247661Medicaid
NY000 528 268 001OtherBC BS OF WNY
NY6213037OtherINDEPENDENT HEALTH