Provider Demographics
NPI:1679785034
Name:COPPOLA, MARIA ELLEN (MS, CCC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELLEN
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 MASSACHUSETTS AVE
Mailing Address - Street 2:UNIT 106
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8450
Mailing Address - Country:US
Mailing Address - Phone:781-316-2919
Mailing Address - Fax:
Practice Address - Street 1:264 MASSACHUSETTS AVE
Practice Address - Street 2:UNIT 106
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8450
Practice Address - Country:US
Practice Address - Phone:781-316-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist