Healthcare Provider Details

I. General information

NPI: 1629479514
Provider Name (Legal Business Name): COPLEY KEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 119TH ST
COLLEGE POINT NY
11356-2516
US

IV. Provider business mailing address

2244 119TH ST
COLLEGE POINT NY
11356-2516
US

V. Phone/Fax

Practice location:
  • Phone: 718-559-0555
  • Fax:
Mailing address:
  • Phone: 718-559-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010774
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: