Provider Demographics
NPI:1528417607
Name:KOPKO VITALE, DEBORAH (LPC, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:KOPKO VITALE
Suffix:
Gender:F
Credentials:LPC, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 COUNTY RT 517
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07418-1804
Mailing Address - Country:US
Mailing Address - Phone:973-764-8845
Mailing Address - Fax:973-936-9719
Practice Address - Street 1:804 COUNTY RT 517
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07418-1804
Practice Address - Country:US
Practice Address - Phone:973-764-8845
Practice Address - Fax:973-936-9719
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00535800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional