Healthcare Provider Details

I. General information

NPI: 1871624171
Provider Name (Legal Business Name): PATRICIA KOPREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 W THUNDERBIRD RD
GLENDALE AZ
85306-4002
US

IV. Provider business mailing address

14815 N 15TH AVE
PHOENIX AZ
85023-5174
US

V. Phone/Fax

Practice location:
  • Phone: 623-486-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: