Provider Demographics
NPI:1518038678
Name:KOPMAN, SANDRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:KOPMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5136
Mailing Address - Country:US
Mailing Address - Phone:516-541-4066
Mailing Address - Fax:631-673-0924
Practice Address - Street 1:1000 PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2740
Practice Address - Country:US
Practice Address - Phone:516-541-4066
Practice Address - Fax:631-673-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0284051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069208OtherVALUE OPTIONS
NY01502065Medicaid
NYP399180OtherOXFORD HEALTH PLAN
NY7400536OtherGHI-BMP
NY75904OtherVYTRA HEALTH PLANS
NY069208OtherVALUE OPTIONS
NY01502065Medicaid