Provider Demographics
NPI:1457825259
Name:COPPERSMITH, CORY (LCSW)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:COPPERSMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 WEST ST RM 213
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2838
Mailing Address - Country:US
Mailing Address - Phone:412-715-7476
Mailing Address - Fax:
Practice Address - Street 1:907 WEST ST RM 213
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2838
Practice Address - Country:US
Practice Address - Phone:412-715-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134378101YM0800X
PACW0282671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW134378OtherSTATE BOARD OF SOCIAL WORK LSW