Provider Demographics
NPI:1700876828
Name:KOPPEL, EVELYN (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:KOPPEL
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PENCOYO AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:856-401-0557
Mailing Address - Fax:610-664-1007
Practice Address - Street 1:1510 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-4626
Practice Address - Country:US
Practice Address - Phone:856-401-0557
Practice Address - Fax:610-664-1007
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00378104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker