Healthcare Provider Details

I. General information

NPI: 1386009058
Provider Name (Legal Business Name): MICHELE KOEPPEL LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 JOG RD STE 109
DELRAY BEACH FL
33446-2164
US

IV. Provider business mailing address

15300 JOG RD STE 109
DELRAY BEACH FL
33446-2164
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-3700
  • Fax: 561-499-3775
Mailing address:
  • Phone: 561-499-3700
  • Fax: 561-499-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8208
License Number StateFL

VIII. Authorized Official

Name: MICHELE KOEPPEL
Title or Position: MA LCSW LFM
Credential: MA LCSW LFM
Phone: 561-499-3700