Provider Demographics
NPI:1831196625
Name:KOPEL, AMY LYNN (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:KOPEL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 KENILWORTH DR
Mailing Address - Street 2:STE 208
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2136
Mailing Address - Country:US
Mailing Address - Phone:410-821-9757
Mailing Address - Fax:
Practice Address - Street 1:6301 N CHARLES ST
Practice Address - Street 2:SUITE 8
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1047
Practice Address - Country:US
Practice Address - Phone:410-377-6370
Practice Address - Fax:410-377-6516
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD925MMedicare ID - Type UnspecifiedPROVIDER NUMBER