Healthcare Provider Details

I. General information

NPI: 1013629427
Provider Name (Legal Business Name): NICOLAS B KOPPELMAN M. ED., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14193 PAVERSTONE TER
DELRAY BEACH FL
33446-2252
US

IV. Provider business mailing address

14193 PAVERSTONE TER
DELRAY BEACH FL
33446-2252
US

V. Phone/Fax

Practice location:
  • Phone: 561-671-8698
  • Fax:
Mailing address:
  • Phone: 561-671-8698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: