Healthcare Provider Details

I. General information

NPI: 1083387856
Provider Name (Legal Business Name): SARAH M. KOPENCEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 S CORBETT AVE
PORTLAND OR
97239-4621
US

IV. Provider business mailing address

12455 SW SILVERTIP ST
BEAVERTON OR
97007-3019
US

V. Phone/Fax

Practice location:
  • Phone: 860-815-2409
  • Fax:
Mailing address:
  • Phone: 860-815-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003816
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4003
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: