Healthcare Provider Details

I. General information

NPI: 1962284836
Provider Name (Legal Business Name): MAXWELL DANIEL KOPEIKIN L-MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 18TH ST STE 211
SAN FRANCISCO CA
94110-2075
US

IV. Provider business mailing address

709 N ELM DR
BEVERLY HILLS CA
90210-3422
US

V. Phone/Fax

Practice location:
  • Phone: 415-598-8848
  • Fax:
Mailing address:
  • Phone: 310-498-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: