Provider Demographics
NPI:1013629427
Name:KOPPELMAN, NICOLAS B (M ED, LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:B
Last Name:KOPPELMAN
Suffix:
Gender:M
Credentials:M ED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14193 PAVERSTONE TER
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2252
Mailing Address - Country:US
Mailing Address - Phone:561-671-8698
Mailing Address - Fax:
Practice Address - Street 1:14193 PAVERSTONE TER
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2252
Practice Address - Country:US
Practice Address - Phone:561-671-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty