Provider Demographics
NPI:1891327177
Name:KOPECKA, MARKETA (LGSW)
Entity Type:Individual
Prefix:
First Name:MARKETA
Middle Name:
Last Name:KOPECKA
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PENNSYLVANIA AVE SE STE 330
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4397
Mailing Address - Country:US
Mailing Address - Phone:202-864-4184
Mailing Address - Fax:
Practice Address - Street 1:650 PENNSYLVANIA AVE SE STE 330
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4397
Practice Address - Country:US
Practice Address - Phone:202-864-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker