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NPI Code Detail

MEDICARE: JACOB COPENHAVER CDCA

MEDICARE: JACOB COPENHAVER CDCA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1780391615
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB COPENHAVER CDCA
Provider Business Mailing Address
First Line : 2020 CARNEGIE AVE LOWR
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2337
Country : US
Telephone Number : 216-859-9500
Fax Number : 216-415-5635
Provider Business Practice Location Address
First Line : 2020 CARNEGIE AVE LOWR
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2337
Country : US
Telephone Number : 216-859-9500
Fax Number : 216-415-5635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2022
Last Update Date : 10/31/2022

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Directions to “ JACOB COPENHAVER CDCA” Practice Location

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