Healthcare Provider Details

I. General information

NPI: 1902156425
Provider Name (Legal Business Name): ANDREW COPPERMAN LMFT 82005
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 TAMAL VISTA BLVD STE 290
CORTE MADERA CA
94925-1159
US

IV. Provider business mailing address

1115 SIR FRANCIS DRAKE #5
KENTFIELD CA
94904
US

V. Phone/Fax

Practice location:
  • Phone: 415-847-8842
  • Fax:
Mailing address:
  • Phone: 415-847-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number82005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: