Healthcare Provider Details

I. General information

NPI: 1306754775
Provider Name (Legal Business Name): MIRA LIBBY COPICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 CASS ST
MONTEREY CA
93940-4517
US

IV. Provider business mailing address

PO BOX 723
MONTEREY CA
93942-0723
US

V. Phone/Fax

Practice location:
  • Phone: 831-886-0002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: