Provider Demographics
NPI:1922471523
Name:KOPPELMAN, REEGAN
Entity Type:Individual
Prefix:
First Name:REEGAN
Middle Name:
Last Name:KOPPELMAN
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 1:4670 LIPSCOMB ST NE STE 11
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2927
Mailing Address - Country:US
Mailing Address - Phone:407-875-3700
Mailing Address - Fax:407-659-0411
Practice Address - Street 1:4670 LIPSCOMB ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2927
Practice Address - Country:US
Practice Address - Phone:321-726-2889
Practice Address - Fax:321-726-2889
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health