Provider Demographics
NPI:1750890117
Name:COPPOLA, CASSANDRA MARIE
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:781-395-0198
Practice Address - Street 1:730 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5906
Practice Address - Country:US
Practice Address - Phone:339-215-6446
Practice Address - Fax:781-395-0198
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker