Provider Demographics
NPI:1639805195
Name:COPELAND, RONNI LAURA
Entity Type:Individual
Prefix:
First Name:RONNI
Middle Name:LAURA
Last Name:COPELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3601
Mailing Address - Country:US
Mailing Address - Phone:609-618-7138
Mailing Address - Fax:
Practice Address - Street 1:407 GLENN AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6109
Practice Address - Country:US
Practice Address - Phone:609-618-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician