Provider Demographics
NPI:1942382536
Name:COPANS, TERRI LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:LYNN
Last Name:COPANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:HOROWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:372 FULLERTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3744
Mailing Address - Country:US
Mailing Address - Phone:845-623-2133
Mailing Address - Fax:
Practice Address - Street 1:327 FULLERTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3726
Practice Address - Country:US
Practice Address - Phone:845-232-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00411400103G00000X
NY015108-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03166781Medicaid
NJ9089403Medicaid
NYA300020901Medicare PIN
NY03166781Medicaid
NJ9089403Medicaid