Healthcare Provider Details

I. General information

NPI: 1336888551
Provider Name (Legal Business Name): MARIANNA KOPP MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 06/04/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST STE 2200
PHILADELPHIA PA
19103-6221
US

IV. Provider business mailing address

1 BRIDLE CT
CHERRY HILL NJ
08003-5157
US

V. Phone/Fax

Practice location:
  • Phone: 215-514-6954
  • Fax:
Mailing address:
  • Phone: 856-383-8879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: