Provider Demographics
NPI:1598805582
Name:KOPICKO, H. DIANA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:H. DIANA
Middle Name:
Last Name:KOPICKO
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 1:2680 BOWERS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICA
Mailing Address - State:DE
Mailing Address - Zip Code:19946-1335
Mailing Address - Country:US
Mailing Address - Phone:302-335-4150
Mailing Address - Fax:308-335-4150
Practice Address - Street 1:122 E CAMDEN WYOMING AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-1302
Practice Address - Country:US
Practice Address - Phone:302-335-4150
Practice Address - Fax:302-335-4150
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007361041C0700X
PACW0145761041C0700X
NJ44SC052393001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035856 1041C0700Medicaid
DE2455127000OtherBCBS
DE2455127000OtherBCBS