Healthcare Provider Details

I. General information

NPI: 1518038678
Provider Name (Legal Business Name): SANDRA KOPMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PARK BLVD SUITE 201
MASSAPEQUA PARK NY
11762-2740
US

IV. Provider business mailing address

59 ARBOR LN
DIX HILLS NY
11746-5136
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-4066
  • Fax: 631-673-0924
Mailing address:
  • Phone: 516-541-4066
  • Fax: 631-673-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR028405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: