Healthcare Provider Details

I. General information

NPI: 1306122130
Provider Name (Legal Business Name): ARDEEN PATRICIA COPELAND-LUPTON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MITCHELLS CHANCE ROAD SUITE 260
EDGEWATER MD
21037-2794
US

IV. Provider business mailing address

3175 WEST WARD ROAD SUITE 200
DUNKIRK MD
20754-3024
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-5300
  • Fax: 410-956-5301
Mailing address:
  • Phone: 410-286-0664
  • Fax: 410-286-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09235
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: