Healthcare Provider Details

I. General information

NPI: 1215213541
Provider Name (Legal Business Name): JUDITH AMY COPELAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 10/14/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 S TREMONT ST
OCEANSIDE CA
92054-5309
US

IV. Provider business mailing address

11348 VISTA SORRENTO PKWY APT 101
SAN DIEGO CA
92130-7650
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-2800
  • Fax: 760-433-5031
Mailing address:
  • Phone: 858-342-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: