Healthcare Provider Details

I. General information

NPI: 1316289721
Provider Name (Legal Business Name): KURT MICHAEL BOPP MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 PIERSON AVE 2ND FLOOR
EDISON NJ
08837-3118
US

IV. Provider business mailing address

530 RUNYON AVE
PISCATAWAY NJ
08854-4717
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-8558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05507800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: