Provider Demographics
NPI:1619062841
Name:KOPPEL, DONALD K (LCSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:K
Last Name:KOPPEL
Suffix:
Gender:M
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1653
Mailing Address - Country:US
Mailing Address - Phone:609-641-2500
Mailing Address - Fax:609-641-2502
Practice Address - Street 1:600 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1653
Practice Address - Country:US
Practice Address - Phone:609-641-2500
Practice Address - Fax:609-641-2502
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS29702Medicare UPIN
NJ638905NKSMedicare ID - Type Unspecified