Healthcare Provider Details

I. General information

NPI: 1558486241
Provider Name (Legal Business Name): NANCY L KOPPEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3171 N MERIDIAN ST
INDIANAPOLIS IN
46208-4784
US

IV. Provider business mailing address

7823 SUNSET LN
INDIANAPOLIS IN
46260-3575
US

V. Phone/Fax

Practice location:
  • Phone: 317-941-5010
  • Fax:
Mailing address:
  • Phone: 317-255-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3400762A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: