Provider Demographics
NPI:1700429354
Name:KOPEYKINA, IRINA (MHC)
Entity Type:Individual
Prefix:MS
First Name:IRINA
Middle Name:
Last Name:KOPEYKINA
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 ALEX CIR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4765
Mailing Address - Country:US
Mailing Address - Phone:646-824-6067
Mailing Address - Fax:
Practice Address - Street 1:20 E 46TH ST RM 1200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9246
Practice Address - Country:US
Practice Address - Phone:646-850-2293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP102077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health