MEDICARE: COPLEY KEMP

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	010774	NY

General Provider Information

NPI Number	:	1629479514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COPLEY KEMP

Provider Business Mailing Address
First Line	:	2244 119TH ST
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2516
Country	:	US
Telephone Number	:	718-559-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2244 119TH ST
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2516
Country	:	US
Telephone Number	:	718-559-0555
Fax Number	:

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

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	05/26/2026

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Directions to “ COPLEY KEMP ” Practice Location

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