Healthcare Provider Details

I. General information

NPI: 1326325945
Provider Name (Legal Business Name): DEBRA M KOOPMAN MS, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 WORCESTER RD STE 203
FRAMINGHAM MA
01701-5410
US

IV. Provider business mailing address

1881 WORCESTER RD STE 203
FRAMINGHAM MA
01701-5410
US

V. Phone/Fax

Practice location:
  • Phone: 508-834-3183
  • Fax: 508-532-1168
Mailing address:
  • Phone: 508-834-3183
  • Fax: 508-532-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberMK2499867
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN2264988
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2264988
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: