Healthcare Provider Details

I. General information

NPI: 1740557115
Provider Name (Legal Business Name): MELANIE PATRICIA KOPANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 E HIGH ST
POTTSTOWN PA
19464-3211
US

IV. Provider business mailing address

2091 E HIGH ST
POTTSTOWN PA
19464-3211
US

V. Phone/Fax

Practice location:
  • Phone: 610-970-5234
  • Fax:
Mailing address:
  • Phone: 610-970-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016020
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: