Provider Demographics
NPI:1578879508
Name:KOPSICK, GINNEL LOUISE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:GINNEL
Middle Name:LOUISE
Last Name:KOPSICK
Suffix:
Gender:F
Credentials: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:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-0183
Mailing Address - Country:US
Mailing Address - Phone:518-669-8149
Mailing Address - Fax:
Practice Address - Street 1:28 SPRING ST
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-2173
Practice Address - Country:US
Practice Address - Phone:518-669-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0815761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04686839Medicaid
NY0300428Medicaid