Healthcare Provider Details

I. General information

NPI: 1578879508
Provider Name (Legal Business Name): GINNEL LOUISE KOPSICK LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SPRING ST
BROADALBIN NY
12025-2173
US

IV. Provider business mailing address

PO BOX 183
BROADALBIN NY
12025-0183
US

V. Phone/Fax

Practice location:
  • Phone: 518-669-8149
  • Fax:
Mailing address:
  • Phone: 518-669-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: