Healthcare Provider Details

I. General information

NPI: 1144387911
Provider Name (Legal Business Name): JUDY ROBIN KOPMAN-FRIED LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 YALE AVE
WALLINGFORD CT
06492-1858
US

IV. Provider business mailing address

950 YALE AVE
WALLINGFORD CT
06492-1858
US

V. Phone/Fax

Practice location:
  • Phone: 203-269-3488
  • Fax: 203-272-6163
Mailing address:
  • Phone: 203-269-3488
  • Fax: 203-272-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000579
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: