Provider Demographics
NPI:1336888551
Name:KOPP, MARIANNA (MFT)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:KOPP
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRIDLE CT
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-5157
Mailing Address - Country:US
Mailing Address - Phone:856-383-8879
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6221
Practice Address - Country:US
Practice Address - Phone:215-514-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health