Healthcare Provider Details

I. General information

NPI: 1164150322
Provider Name (Legal Business Name): ISABEL SARA FELLER-KOPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 OLD ROAD TO 9 ACRE COR
CONCORD MA
01742-4169
US

IV. Provider business mailing address

133 OLD ROAD TO 9 ACRE COR
CONCORD MA
01742-4169
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3173
  • Fax:
Mailing address:
  • Phone: 978-287-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW230841
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: