Provider Demographics
NPI:1184908592
Name:COPPOLA, ASHLEY R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:R
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LEO CT
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5408
Mailing Address - Country:US
Mailing Address - Phone:203-491-0282
Mailing Address - Fax:
Practice Address - Street 1:19 LEO CT
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5408
Practice Address - Country:US
Practice Address - Phone:413-768-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT94851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical