Healthcare Provider Details

I. General information

NPI: 1528077104
Provider Name (Legal Business Name): CARA L KOPLAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E INDIANTOWN RD STE 310
JUPITER FL
33477-5153
US

IV. Provider business mailing address

9458 154TH ROAD NORTH
JUPITER FL
33478
US

V. Phone/Fax

Practice location:
  • Phone: 561-748-1209
  • Fax: 561-748-1209
Mailing address:
  • Phone: 561-748-1209
  • Fax: 561-748-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: