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General NPI Number Information
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NPI Number | 1093351371
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Entity Type | Individual
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Provider Name | FARRAH CLARE COPPOLINO
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Gender | Female
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 418 CENTRAL AVE
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City | WESTFIELD
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State | NJ
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Zip | 07090-2521
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Country | US
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Telephone | 888-261-1110
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Fax | 732-204-1636
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Provider Business Mailing Address
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Address Line | 5 SMITHFIELD CT
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-2777
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Country | US
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Telephone | 908-907-6323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-76296
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License Number State | NJ
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