Provider Demographics
NPI:1851663165
Name:LACOPPOLA, KELLEI SUE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KELLEI
Middle Name:SUE
Last Name:LACOPPOLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11-21 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-3968
Mailing Address - Country:US
Mailing Address - Phone:518-993-2273
Mailing Address - Fax:518-993-2280
Practice Address - Street 1:11-21 BROADWAY
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-3968
Practice Address - Country:US
Practice Address - Phone:518-993-2273
Practice Address - Fax:518-993-2280
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool