Provider Demographics
NPI:1942561956
Name:PHYLLIS KOPIT, LLC
Entity Type:Organization
Organization Name:PHYLLIS KOPIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPIT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-868-7063
Mailing Address - Street 1:20H HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-7916
Mailing Address - Country:US
Mailing Address - Phone:973-868-7063
Mailing Address - Fax:
Practice Address - Street 1:20 COMMUNITY PL
Practice Address - Street 2:SUITE 400
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7500
Practice Address - Country:US
Practice Address - Phone:973-868-7063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045481001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty