Healthcare Provider Details

I. General information

NPI: 1285075259
Provider Name (Legal Business Name): HALEY KOPERSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 PINE ST
BURLINGTON VT
05401-5353
US

IV. Provider business mailing address

208 FLYNN AVE SUITE 3J
BURLINGTON VT
05401-5429
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0102660
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: