MEDICARE: DR. KRISTIN KOPPLE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist	PS018288	PA

General Provider Information

NPI Number	:	1215240395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN KOPPLE PH.D.

Provider Business Mailing Address
First Line	:	1315 WALNUT ST STE 1700
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4717
Country	:	US
Telephone Number	:	215-850-3490
Fax Number	:	215-545-8496

Provider Business Practice Location Address
First Line	:	1315 WALNUT ST STE 1700
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4717
Country	:	US
Telephone Number	:	215-850-3490
Fax Number	:	215-545-8496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	10/26/2018

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